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Columbia  Winibtv^itp 
in  tf)t  Citp  of  i^etD  gorfe 

College  of  ^tp^iciang  anb  burgeons 


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EPHRAiM  McDowell 

"FATHER  OF  OVARIOTOMY" 

AND 

FOUNDER  OF  ABDOMINAL  SURGERY 


WITH  AN  APPENDIX 
ON 

JANE  TODD  CRAWFORD 
By  august  SCHACHNER,  M.D.,  F.A.C.S. 

LOUISVILLE,  KENTUCKY 

21  ILLUSTRATIONS 


A  Few  Opinions  and  Reviews 

Dr.  George  W.  Crile,  Western  Reserve  University: 

"I  want  to  congratulate  you  on  an  excellent  piece  of  work 
and  one  of  real  value  in  the  history  of  medicine." 

Mr.  Desha  Breckinridge,  Lexington,  Ky. : 

"As  a  Kentuckian  I  thank  you  for  having  done  this  work 
though  the  gratitude  should  not  be — and  will  not  be — 
bounded  by  State  lines." 

Dr.  Lewis  S.  Pilcher,  Editor,  Annals  of  Surgery : 

"The  whole  profession  is  indebted  to  you  for  the  work 
which  you  have  performed  for  the  honor  of  McDowell." 

Bulletin  of  Johns  Hopkins  Hospital: 

"In  this  delightfully  written  work  we  have  all  the  data  for 
a  complete  history  of  one  of  our  great  medical  pioneers,  if 
not,  indeed,  the  greatest.  It  has  taken  years  of  patient 
research  to  coUect  all  the  facts  of  the  life  of  this  great 
doctor-frontiersman,  and  of  his  heroic  patient,  Jane 
Crawford,  so  that  Schachner's  work  is  conspicuous  for  its 
untiring  industry,  and  stands  out  as  a  model  for  future 
historians." 

The  Lancet)  London: 

"Altogether,  Dr.  Schachner  has  produced  a  most  inter- 
esting work." 

Journal  of  the  American  Medical  Association: 

"As  a  statement  of  the  facts,  and  as  a  contribution  to 
medical  history,  Dr.  Schachner's  book  deserves  great 
credit  and  commendation." 

Dr.  Howard  A.  Kelly,  Johns  Hopkins  University : 

"Your  McDowell  book  is  fine,  a  classic,  delightfully 
written  and  full  of  valuable  information." 

The  American  Journal  of  the  Medical  Sciences: 

"The  author  is  to  be  congratulated  upon  the  thoroughness 
of  his  work." 

Southern  Medical  Journal: 

"This  new  biography  by  Schachner  is  easily  the  most 
complete  and  authoritative  that  has  yet  appeared  on 
McDowell." 


A  Few  Opinions  and  Reviews 

The  American  Historical  Review : 

"The  details  of  McDowell's  and  of  Mrs.  Crawford's  lives 
are  delightfully  set  forth  in  this  most  readable  book." 

"We  have  here  an  acceptable  classic  to  add  to  our  sparse 
literature  of  medical  heroes." 

Bulletin  of  the  Society  of  Medical  History  of  Chicago: 

"The  medical  historian  will  find  this  a  valuable  book  and 
even  the  general  reader,  browsing  here  and  there  through 
its  pages,  will  find  many  things  which  may  interest  and, 
perhaps  even  amuse  him.  The  publishers  have  issued  the 
volume  in  such  style  as  to  make  it  exceedingly  attractive 
as  a  gift  book." 

Annals  of  Surgery : 

"In  this  delightful  book  of  Schachner's  from  every  pos- 
sible viewpoint  the  career  of  McDowell  is  presented  with 
much  fullness.  The  author  has  produced  more  than 
biographies  of  the  two  great  actors  in  this  drama  of  the 
first  ovariotomy.  He  has  given  us  a  critical  study  of  the 
man  and  his  time." 

The  Journal  of  the  Missouri  State  Medical  Association : 

"This  volume  is  a  splendid  tribute  by  a  loyal  Kentuckian 
to  the  greatest  medical  man  of  his  State." 

"Dr.  Schachner  has  given  us  an  authentic  work  which 
will  long  be  used  by  research  workers  who  are  seeking  first- 
hand knowledge  of  many  of  the  facts  concerning  the  life 
and  times  of  McDowell." 

The  Boston  Medical  and  Surgical  Journal: 

"The  book  is  very  interesting,  and  well  worth  careful 
reading.  Pictures,  paper,  letter-press  and  binding  are 
also  worthy  of  much  praise." 

Medical  Record,  New  York: 

"McDowell  is  such  an  outstanding  figure  in  the  history  of 
American  surgery  that  this  new  volume  is  most  welcome 
and  the  author  is  to  be  congratulated  on  the  mass  of  facts 
which  he  has  accumulated." 


A  Few  Opinions  and  Reviews 

The  Journal  of  the  lozva  State  Medical  Society: 

"The  author  of  this  biography  b}^  a  most  thorough  anal- 
ysis has  clearly  shown  what  kind  of  a  man  McDowell  was, 
and  how  much  is  due  him  in  laying  the  foundation  of 
abdominal  surgery." 

Colorado  Medicine : 

"This  is  a  well-written  memorial  to  the  dauntless  father 
of  ovariotomy,  who  put  into  practice  what  all  the  great 
teachers  of  Europe  discussed  and  debated  academically, 
but  hesitated  to  attempt." 

California  State  Journal  of  Medicine: 

Instead  of  the  Saturday  Evening  Post  take  this  book  with 
you  the  next  time  3^ou  spend  a  few  days  on  a  Pullman." 


ORDER  FORM 

Gentlemen: — 

Please  send  me  via  IZ^.r"' 
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EPHRAiM  McDowell 

By  AUGUST  SCHACHNER 

for  which  I  enclose  $ ($5.00  net  per  copy) 

Check  enclosed Charge  to  My  Account Send  C.  O.  D 

Name 


Address 


Octavo.     313  Pages.     Illustrated. 


J.  B.  LIPPINCOTT  COMPANY 

PUBLISHERS  PHILADELPHIA 


Digitized  by  tine  Internet  Arciiive 

in  2010  witii  funding  from 

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http://www.archive.org/details/ephraimmcdowellfOOscha 


EPHRAiM  Mcdowell 

"FATHER  OF  OVARIOTOMY"  AND 
FOUNDER  OF  ABDOMINAL  SURGERY 


Dr.  Ephraim  McDowell.    From    a  Portrait  in  possession    of  his  granddaughter, 
Mrs.  William  M.  Irvine,  Richmond,  Ky. 


EPHRAiM  Mcdowell 

"FATHER  OF  OVARIOTOMY" 

AND 

FOUNDER  OF  ABDOMINAL  SURGERY 


WITH  AN  APPENDIX 

ON 

JANE  TODD  CRAWFORD 


BY 

AUGUST  SCHACHNER,  M.D.,  F.A.C.S. 

LOUISVILLE,  KENTUCBTV 


PHILADELPHIA  AND  LONDON 

J.  B.  LIPPINCOTT  COMPANY 

1921 


COPYRIGHT,  1921,  BY  THE  J.  B.  LIPPINCOTT  COMPANY 


■RlS4-.V^"\\4- 


"ScVv  S" 


PRINTED  BY  THE  J.  B.  LIPPINCOTT  COMPANY 

AT  THE  WASHINGTON  SQUARE  PRESS 

PHILADELPHIA,  U.  S.  A. 


TO  MY  PARENTS 


PREFACE 

The  motive  for  undertaking  this  work,  the  aims  in- 
volved therein,  and  the  results,  which  I  hope  have  at 
least  in  part  been  accomplished,  are  set  forth  in  detail  in 
the  foreword. 

Much  as  I  have  endeavored  to  avoid  it,  a  certain  degree 
of  repetition  was  inevitable,  and  for  this  I  offer  the  reader 
my  apology. 

Although  I  have  faithfully  labored  to  present  the  facts, 
I  do  not  flatter  myself  that  the  following  pages  are  entirely 
free  from  error,  and  therefore  beg  the  indulgence  of  the 
reader  for  any  errors  or  omissions  that  may  have  crept  in. 

I  have  made  free  use  of  N.  S.  Shaler's  work,  *' A  Pioneer 
Commonwealth,"  in  the  historical  sketch  of  Virginia  and 
Kentucky,  as  well  as  of  the  brochure  of  Dr.  Eugene  R. 
Corson  on  "John  Bell — Surgeon,  "in  my  sketch  of  John  Bell. 

Extracts  from  the  writings  of  others  have  been  added, 
not  alone  as  proper  correlatives  to  the  biographies  of 
Ephraim  McDowell  and  Jane  Todd  Crawford,  but  also 
for  the  convenience  of  future  students  of  the  lives  of  these 
benefactors  of  the  human  race. 

While  I  have  endeavored  to  give  credit  to  those  authors 
from  whose  contributions  extracts  have  been  made,  I  also 
confess  my  indebtedness  to  those  authors  from  whose 
contributions  extracts  were  not  made,  but  whose  writings 

have  influenced  and  aided  me  in  this  undertaking. 

vii 


PREFACE 

I  further  desire  to  acknowledge  my  deep  sense  of 
obligation  to  Mr.  Henry  Hesse,  for  the  splendid  photo- 
graphs which  he  has  expressly  prepared  for  this  work;  to 
Mr.  J.  Knox  Mitchell,  of  Osborne,  Kansas,  for  his  patient 
and  painstaking  assistance  in  developing  the  details  of 
the  Crawford  family  history,  and  in  the  discovery  of  the 
grave  of  Mrs.  Crawford;  and,  lastly,  to  offer  my  profound 
thanks  to  all  others  who  have  directly  or  indirectly  aided 

me  in  this  task. 

The  Author 


CONTENTS 


CHAPTER  PAGE 

Foreword xiii 

I.  Ancestry  of  Dr.  Ephraim  McDowell — ^The  Settlers  on  Bur- 
den's Grant — The  Early  Development  of  Kentucky — Dr. 
Ephraim  McDowell,  His  Birth  and  Boyhood — Danville 
IN  its  Early  Stages — The  Education  of  McDowell — Dr. 
Alexander  Humphreys,  the  Preceptor  of  McDowell.  .. 

II.  Leaves  for  Edinburgh — American  Associates  in  Edinburgh — 
Vacation  in  Scotland — Prof.  A.  R.  Simpson's  Study  of 
McDowell  While  Attending  the  University  of  Edin- 
burgh— Becomes  a  Pupil  of  John  Bell — Sketch  of  John 
Bell — Influences  of  the  Frontier,  and  Dependence  of 
the  First  Ovariotomy  upon  the  Freedom  of  the  Frontier    21 

III.  McDowell  Left  Edinburgh  Without  His  Degree — Notable 

Contemporaries  During  His  Career — Transylvania  Uni- 
versity— Characteristics  of  His  Practice — His  Priceless 
Service  to  Humanity 44 

IV.  The    Memorable    Case    of    Mrs.    Jane    Todd    Crawford — 

McDowell's  Defense  of  His  Claims — ^Analysis  of  the 
Operation — Locating  the  Operating  Room — The  Tradi- 
tion of  the  Mob — His  Rights  to  the  Title  of  Father  of 
Ovariotomy  and  Founder  of  Abdominal  Surgery 61 

V.  McDowell's  Report  of  His  First  Three  Cases — Dr.  James 
Johnson's  Criticisms  of  McDowell  —  The  Contribution 
OF  John  Lizars — "Observations  on  Extirpation  of  the 
OvARiA,  with  Cases" — Fate  of  McDowell's  Report  in  the 
Hands  of  Philip  Syng  Physick  and  Thomas  Chalkley 
James 86 

VI.  McDowell's  Second  Report — Remarks  upon  McDowell's 
Course  of  Procedure — ^Analytical  Table  of  His  Cases — 
Report  of  His  Unpublished  Cases — ^Total  Number  of 
His  Ovarian  Operations 109 

VII.  The  Tradition  that  His  Operations  Were  Performed  upon 
Negro  Slaves — Review  of  the  Attempts  to  Deprive  Him 
of  His  Honors — The  Comments  of  Sir  T.  Spencer  Wells  131 
ix 


CONTENTS 

VIII.  "A  Dropsy  of  the  Left  Ovary  Cured,"  by  Robert  Houstoun 
— ^The  Comments  of  Mr.  Lawson  Tait — ^Analysis  of 
Houstoun's  Claims  by  Mr.  J.  Grieg  Smith — ^McDowell's 
Supposed  Predecessors — Early  Progress  of  Ovariotomy 
— Chrysmar's  Cases 146 

IX.  The  Opposition  of  the  Early  French  School — ^The  History 
of  an  Emphysema  by  William  Hunter — ^The  R5le  of  the 
British  School. 174 

X.  The  Personal  Side  of  Dr.  Ephraim  McDowell 204 

XI.  The  Portraits  of  McDowell — The  Movement  in  Honor  of 
His  Memory — ^The  Memorial  Monument  and  Dedicatory 
Exercises 223 

Xn.  The  Centennial  Celebration  of  the  First  Ovariotomy — 
Efforts  to  Memorialize  the  McDowell  House — 
Author's  Address  Before  the  Kentucky  State  Fede- 
ration  of   Women's  Clubs 25 1 

Xni.  Review  of  the  Correspondence  and  Efforts  to  Purchase 
THE  House — Descriptive  Text  of  the  Ground  Plan  of 
THE  McDowell  House 266 

XIV.  Jane  Todd  Crawford,  the  Heroine  of  the  First  Ovariotomy.  284 


ILLUSTRATIONS 


PAGE 

Dr.  Ephraim  McDowell Frontispiece 

Coat  of  Arms  of  the  McDowell  Family 3 

The  McDowell  House.    Front  View 69 

The  McDowell  House.    Rear  View 73 

Dr.  McDowell's  Office 77 

Front  Hall  of  McDowell  House 77 

Cover  Page  of  the  Eclectic  Repertory 119 

Traveler's  Rest 217 

Cambuskenneth 219 

The  First  Graves  of  Dr.  Ephraim  McDowell  and  Mrs.  McDowell  221 

Fragments  of  First  Tombstone 221 

The  Knapp  Portrait  of  Dr.  Ephraim  McDowell 229 

"The  First  Ovariotomy" 231 

Memorial  Monument  in  Danville 243 

The  McDowell  Door  Knocker 249 

The  McDowell  Memorial  Medallion 255 

Plan  of  McDowell  House.    Ground  Floor 281 

Plan  of  McDowell  House.    Second  Floor 281 

Crawford  Cabin 296 

Hon.  Thomas  Howell  Crawford 301 

Grave  of  Jane  Todd  Crawford 309 


FOREWORD 

While  on  a  vacation  In  Europe  during  the  summer  of 
191 1,  I  visited  the  Universitats-Frauenkhnik,  in  Berlin. 
As  I  passed  through  the  arched  entrance  to  the  amphi- 
theatre, I  noticed  an  engraving  of  Dr.  Ephraim  McDowell 
on  the  one  side,  and  an  engraving  of  a  woman  on  the  other. 
These  were  the  only  ornaments  that  adorned  the  clinic. 
I  conveyed  to  the  chief  of  the  clinic  my  sense  of  pleasure 
at  seeing  my  illustrious  countryman  so  honored,  and 
casually  added,  "The  other,  no  doubt,  is  the  heroic 
Mrs.  Crawford." 

He  replied,  "We  think  this  is  an  appropriat;e  place  for 
a  likeness  of  your  distinguished  countryman;  however, 
the  other  picture  is  not  that  of  Mrs.  Crawford,  but  of  a 
patient  upon  whom  we  successfully  performed  several 
Cesarean  sections,  and  we  therefore  accord  to  her  likewise 
a  place  of  honor  in  the  clinic.'* 

My  presentation  to  Geh.  Med. — Rat.  Ernst  Bumm 
followed  a  few  minutes  thereafter,  and  in  the  introduction 
the  foregoing  incident  was  dwelt  upon  by  the  chief  of 
the  clinic.  Almost  immediately  Professor  Bumm  asked, 
"Is  it  true  that  McDowell  did  his  first  ovariotomy  upon 
a  negro  slave?"  I  assured  him  that  to  the  best  of  my 
knowledge  such  was  not  the  case.  He  then  added,  "Here 
in  Germany  it  is  tLc  belief  that  McDowell's  first  ovari- 
otomy was  performed  upon  a  negro  slave." 

After  an   interesting   discussion  upon  this   subject, 
promised  Professor  Bumm  to  investigate   carefully  the 
several  points  raised  in  the  conversation  and  to  communi- 
cate to  him  or  publish  the  result  of  my  inquiry. 

This  promise  was  fulfilled  in  the  form  of  a  paper 
entitled,  "Dr.  Ephraim  McDowell,  *  Father  of  Ovariot- 
omy'; His  Life  and  His  Work,"  which  was  read  before 


FOREWORD 

The  Johns  Hopkins  Historical  Club,  December  9,  1912, 

This  inquiry  was  scarcely  more  than  under  way,  when 
I  became  convinced  of  the  wisdom  and  the  necessity  of 
a  careful  study  of  McDowell;  and  the  further  it  proceeded, 
the  more  I  became  impressed  with  its  importance.  Writers 
have  not  only  copied  from  one  another  without  investi- 
gation, thus  perpetuating  errors,  but  in  some  instances 
the  same  writers  have  contradicted  themselves.  The 
difficulty  of  securing  reliable  details  of  his  life  became 
quickly  apparent;  and  the  conflicting  dates  of  his  birth 
and  death  were  soon  discovered.  As  for  the  heroine,  she 
had  been  handed  about  for  a  century  from  one  writer  to 
the  other,  merely  as  Mrs.  Crawford,  and  all  efforts  to 
give  her  the  exact  place  in  history  which  she  had  always 
deserved,  but  had  never  received,  seemed  for  a  time 
utterly  futile. 

Not  in  the  least  do  I  believe  that  it  disturbs  the  great- 
ness of  Ephraim  McDowell  to  divide  the  glory  of  this 
achievement  with  Jane  Todd  Crawford,  who,  by  combin- 
ing her  heroism  with  McDowell's  genius,  made  possible 
the  scientific  advancement  which  directly  and  indirectly, 
forever  aftenvard,  so  immieasurably  contributed  to  the 
benefit  of  the  human  race  of  every  age  and  clime. 

To  stimulate  an  interest  therein,  and  to  facilitate  an 
understanding  of  this  biographical  study,  a  preliminary 
resume  of  the  views  is  submitted. 

In  addition  to  the  life  histories  of  the  hero  and  heroine 
with  which  it  deals,  certain  viewpoints,  which  hitherto 
have  been  overlooked  or  interpreted  differently,  are  ana- 
lyzed and  elaborated  upon. 

Prominent  among  these  impressions  may  be  mentioned 
the  influence  of  John  Bell  upon  McDowell  and  his  first 
ovariotomy.  This  influence  has  been  largely  overrated, 
and  I  believe  greatly  misunderstood. 

To  a  backwoodsman  like  McDowell,  who  had  been 

xiv 


FOREWORD 

reared  in  an  atmosphere  of  independence  and  self-reliance, 
and  who  was  living  in  a  free  country  during  a  particularly 
free  period,  it  is  entirely  natural  that  a  character  like 
John  Bell,  brainy,  brilliant,  and  militant,  then  easily  the 
ablest  surgical  mind  in  Scotland,  should  prove  attractive, 
and  that,  through  contact  with  him,  McDowell 
should  receive  an  inspiration  which  probably  largely  sus- 
tained him  throughout  his  entire  professional  career. 

But  the  views  which  John  Bell  elucidated,  especially 
upon  ovarian  tumors,  were  not  original  with  him.  He 
merely  presented  the  status  of  ovariotomy  as  it  then 
existed.  No  doubt  these  views  were  clearly  and  cogently 
presented,  as  John  Bell  could  hardly  have  presented  them 
otherwise  if  he  tried. 

He  was  an  enthusiast  by  nature  who  did  everything 
that  he  undertook  to  do  with  all  the  fervor  of  his  soul, 
whether  it  was  lecturing  upon  surgery,  struggling  with 
one  of  his  professional  opponents,  or,  even  while  in  his 
last  illness,  preparing  a  set  of  travel  notes  upon  the  archi- 
tecture of  Italy. 

At  the  time  that  McDowell  became  one  of  his  private 
pupils,  the  subject  of  ovariotomy  had  been  considered 
and  debated  upon  in  an  academic  way  for  fully  a  century. 
No  credit  for  any  originality  is  due  John  Bell,  and  even 
less  to  the  Hunters,  John  and  William,  especially  the  latter 
who,  if  his  views  are  properly  considered,  did  much  to 
discourage  the  performance  of  ovariotomy. 

For  years  before  McDowell  performed  his  first  ovari- 
otomy, the  time  was  ripe,  and  all  that  was  lacking  was 
the  man  with  the  necessary  courage  and  the  opportunity. 
When  these  two  conditions  were  finally  fulfilled  in 
Ephraim  McDowell  and  Jane  Todd  Crawford,  the  opera- 
tion of  ovariotomy  passed  from  the  academic  realm  to  the 
state  of  actual  realization. 

Had  McDowell,  however,  lived  under  the  shadow  of 


FOREWORD 

the  University  of  Edinburgh,  it  is  more  than  Hkely  that 
he  would  never  have  been  the  first  ovariotomist. 

It  was  largely  because  of  such  an  overpowering  con- 
servatism that  John  Lizars,  a  pupil  of  John  Bell,  a  man 
of  unusual  surgical  ability,  hesitated  for  years,  and  finally 
floundered  about  in  the  operation  almost  a  decade  after 
McDowell's  first  experience. 

It  was  McDowell's  frontier  location  on  the  very  fringe 
of  civilization,  where  freedom  and  self-reliance  reigned 
supreme,  that  made  the  first  ovariotomy  possible.  Al- 
though the  operation  was  the  ultimate  outcome  of  a 
gradual  evolution  in  an  academic  way,  it  was  first  per- 
formed by  the  backwoodsmen  of  America,  Germany, 
England,  France,  and  Italy,  and  was,  in  the  beginning, 
systematically  condemned  and  opposed  by  the  metro- 
politan surgeons  of  those  countries. 

Confronted  with  the  opportunity,  thrown  upon  his 
own  resources,  under  the  guidance  of  his  "mother wit," 
McDowell  calmly  enacted  a  role  that  justly  immortalized 
him  and  his  heroine,  and,  indirectly,  laid  the  cornerstone 
for  the  most  brilHant  domain  of  surgery. 

The  influence  of  his  fife  is  only  fully  realized  when  we 
compare  his  achievement  with  that  of  vaccination,  anaes- 
thesia, and  the  Listerian  doctrine  of  surgery. 

The  only  drawback,  if  we  may  call  it  such,  that 
attended  his  being  a  backwoodsman,  a  "doctor"  prac- 
ticing without  a  diploma,  was  that  through  these  circum- 
stances he  was  exposed  to  doubt,  contempt,  and  ridicule 
when  he  first  published  his  cases.  This  experience  illus- 
trates a  moral,  that  might  with  advantage  be  studied  by 
a  certain  type  of  the  present-day  reformer  who  works 
overtime  to  standardize  everything  with  machine-Hke 
exactness,  until  every  vestige  of  individuality,  upon 
which  progress  after  all  is  dependent,  becomes  endangered. 

The   attitude  of  the  British  toward   ovariotomy  is 


FOREWORD 

emphasized  on  the  one  hand  by  their  unwilHngness  to 
accord  to  America  in  general,  and  to  McDowell  in  par- 
ticular, the  credit  and  the  honor  they  deserve;  and,  on  the 
other  hand,  by  their  keenness,  and  promptness  in  recogniz- 
ing the  full  importance  of  ovariotomy,  which  established 
the  possibility  of  surgically  invading  the  peritoneal  cavity, 
thus  laying  the  cornerstone  of  abdominal  surgery. 

The  views,  more  especially  of  Mr.  Lawson  Tait  and  of 
Sir  Spencer  Wells,  in  opposition  to  our  contentions,  upon 
the  other  side  of  the  Atlantic,  and  the  uniformly  corro- 
borative expressions  of  our  claims  to  the  honor  by  Oliver 
Wendell  Holmes,  Lewis  Rogers  (Presidential  Address, 
K.S.M.S.);  J.  W.  Thompson  (Presidential  Address, 
K.S.M.S.);  J.  M.  Kellar,  and  Lunsford  Pitts  Yandell,  Sr., 
upon  this  side  justify  our  conclusion. 

The  all-important  fact  is  that  the  earlier  operations, 
in  addition  to  demonstrating  the  feasibility  of  ovari- 
otomy, emphasized  the  possibility  of  invading  the  peri- 
toneal cavity. 

This  was  quickly  recognized  in  earlier  times,  but  later 
on  was  so  completely  overlooked  as  to  be,  historically 
speaking,  practically  lost  in  the  present  period. 

The  promptness  with  which  the  British  seized  upon 
this  idea,  which  in  that  epoch  was  secondary  to  ovari- 
otomy, but  in  time  became  the  basis  for  the  future  realm 
of  abdominal  surgery,  and  tnus  later  on  completely  over- 
shadowed in  importance  the  primary  event,  is  worthy  of 
a  special  mention. 

Lizars,  JeafFreson,  and  the  editor  of  the  Edinburgh 
Medical  and  Surgical  Journal  are  prominent  among  those 
in  that  group. 

Through  the  full  recognition  of  this  surgical  possibility, 
the  awe  in  which  the  peritoneum  had  hitherto  been  held 
was  dissipated;  and    with  its  disappearance,  with  the 


FOREWORD 

advent  of  anaesthesia,  and  later  on  with  the  development 
of  modern  surgery,  came  the  full  fruition  of  McDowell's 
labors,  and  the  almost  incredible  evolution  of  abdomi- 
nal surgery. 

It  can  hardly  be  fairly  denied  that  the  priority  of  this 
role  and  the  importance  of  its  influence  justify  the  con- 
ferring upon  McDowell  of  the  title  certainly  of  the  indirect, 
if  not  the  direct,  founder  of  abdominal  surgery. 

It  is  obvious  that  McDowell  could  not  possibly  have 
realized  the  magnitude  of  his  achievement,  nor  could  he 
have  had  the  faintest  conception  of  that  highly  developed 
and  widely  extended  field  which  the  abdominal  surgery  of 
to-day  represents.  In  fact,  the  calmness  of  his  attitude 
toward  ovariotomy  goes  far  toward  supporting  the  view 
that  prevailed  among  some  of  his  contemporaries 
that  he  was  a  "phlegmatic  man.** 

Although  his  associates  urged  him  to  publish  a  re- 
port of  his  cases  there  is  no  substantial  basis  for 
the  opinion  that,  in  the  absence  of  this  urging,  the 
cases  were  in  any  great  danger  of  remaining  unpublish- 
ed. This  view  is  supported  by  the  promptness  and 
vigor  with  which  he  defended  himself  in  his  second 
paper,  which  was  in  the  form  of  a  letter  to  Dr.  Thomas 
C.  James,  and  by  his  card  issued  in  1826  "to  the  physi- 
cians and  surgeons  of  the  West  and  particularly  the 
students  and  faculty  at  Lexington,"  which  meant  the 
Transylvania   University. 

He  differed  from  these  associates  principally  in  being 
less  impulsive  and  more  cautious  than  they,  and  in  wait- 
ing until  he  had  repeated  his  so-called  experiment  until 
it  ceased  to  be  an  experiment,  and  became  an  accom- 
pHshed  fact.  The  traditional  story  that  he  was  seriously 
threatened  by  a  mob  whilst  performing  the  operation  is 
based  more  upon  fiction  than  upon  facts. 


EPHRAiM  Mcdowell 

CHAPTER  I 

ANCESTRY     OF     DR.     EPHRAIM     McDOWELL THE     SETTLERS      ON 

burden's  grant — THE  EARLY  DEVELOPMENT  OF  KENTUCKY 
— DR.     EPHRAIM    McDOWELL,     HIS     BIRTH    AND     BOYHOOD — 

DANVILLE      IN      ITS      EARLY      STAGES THE      EDUCATION      OF 

McDOWELL DR.   ALEXANDER  HUMPHREYS,   THE    PRECEPTOR 

OF  McDOWELL. 

According  to  the  family  tradition,  the  ancestors  of 
Dr.  Ephraim  McDowell  emigrated  from  Scotland  to 
North  Ireland  during  the  Protectorate  of  Cromwell, 
about  the  middle  of  the  seventeenth  century. 

Ephraim  McDowell,  the  great-grandfather  of  Dr. 
Ephraim  McDowell,  fought  in  the  English  Revolution. 
At  the  age  of  1 6  he  was  one  of  the  Scotch-Irish  Presby- 
terian defenders  of  Londonderry,  during  the  troubles  in 
1688,  and  aided  in  resisting  the  besieging  forces  of  James  II 
in  the  memorable  siege  of  1689.  His  wife  was  Margaret 
Irvine,  his  first  cousin.  With  his  two  sons,  John  and 
James,  and  his  daughters,  Mary  and  Margaret,  he  immi- 
grated to  America,  landing  in  Pennsylvania.  It  is  believed 
that  his  wife  died  in  Ireland.  The  date  of  his  arrival 
in  Pennsylvania,  where  he  remained  several  years,  is 
unknown — possibly,  as  thought  by  some,  September  4, 
1729  {Clinton). 

In  Pennsylvania  his  son  John,  who  was  the  grandfather 
of  Dr.  Ephraim  McDowell,  married  Magdalena  Wood,  or 
Woods,  according  to  Waddell.  It  was  here  that  Samuel, 
the  father  of  Dr.  Ephraim  McDowell,  was  born  on  October 
29>  1735-  In  1737  Ephraim  McDowell,  his  son  John,  his 
son-in-law,    John    Greenlee,    and    his    daughter,    Mary 

1 


EPHRAiM  McDowell 

McDowell  Greenlee,  moved  by  way  of  the  lower  Shenan- 
doah Valley  to  what  is  now  Rockbridge  County,  Virginia, 
settling  on  Timber  Ridge,  originally  called  Timber  Grove, 
near  the  present  town  of  Lexington.  They  were  among 
the  first  settlers  in  that  region.  Ephraim,  the  great-grand- 
father of  Dr.  Ephraim  McDowell,  died  at  the  age  of  about 
lOO  and  lies  buried  in  Rockbridge  County,  Virginia. 
According  to  Green: 

The  span  of  Ephraim  McDowell's  life  covered  the  overthrow 
of  the  Stu-arts,  the  rise  of  the  House  of  Hanover,  the  establish- 
ment of  the  Empire  of  Britain  in  India  and  over  the  seas,  the 
wresting  of  New  York  from  the  Dutch,  and  the  expulsion  of  the 
French  from  North  America;  the  erection  of  the  electorate  of 
Brandenburg  into  the  kingdom  of  Prussia;  the  victories  of  Marl- 
borough and  Eugene,  of  the  great  Trederick,  the  consolidation 
of  the  Russian  Empire  under  Peter  and  his  successors,  the 
opening  of  the  great  West  by  the  daring  pioneers,  and  the 
growth  of  liberalism  in  Great  Britain,  France,  and  America. 

Capt.  John  McDowell,  the  father  of  Samuel  McDowell, 
and  the  grandfather  of  Dr.  Ephraim  McDowell,  fell  in  a 
battle  with  the  Indians  on  Christmas  day,  1742  {Peyton^ 
Waddell),  or  1743  {Green).  He  died  defending  the  grant 
of  land  which  he  shared  with  Benjamin  Burden  or  Borden, 
according  to  the  New  Jersey  branch  of  the  family, 
after  whom  Bordentown  of  that  state  was  named.  John 
McDowell  was  Burden's  surveyor  and  he  cooperated  with 
Burden  in  securing  the  necessary  immigrants  to  make  the 
grant  binding.  He  fell  into  an  ambuscade  at  Balcony 
Falls  and  he,  with  eight  of  his  men,  was  killed.  He  left 
three  children,  Samuel,  James  and  Sarah. 

On  the  west  side  of  the  road  from  Staunton  to  Lexing- 
ton, near  Fairfield,  and  close  to  the  Timber  Ridge  Church 
and  the  "Red  House"  or  Maryland  tavern,  formerly  the 
residence  of  John  McDov/ell,  is  a  small  cemetery.    On  the 

2 


—  ^  x^//y 


// 


Coat  of  Arms  of  the  McDowell  family. 


ANCESTRY  OF  DR.  EPHRAIM  McDOWELL 

left  of  the  entrance  is  a  rough  tombstone  marking  the 
grave  of  John  McDowell.  His  widow,  Magdalena  Wood 
(or  Woods)  McDowell,  married  Benjamin  Burden,  Jr., 
son  of  the  grantee.  This  lady  later  entered  on  a  third 
matrimonial  venture  with  Col.  John  Bowyer,  a  gentle- 
man 20  years  younger  than  herself. 

The  104  years  to  which  she  lived  gave  ample  time  for  a 
full  repentance  of  this  singular  matrimonial  adventure.  Tradi- 
tion states  that  Col.  Bowyer  destroyed  the  marital  settlement 
by  which  the  wary  Magdalena  had  essayed  to  secure  her  prop- 
erty to  herself  and  children.  He  outlived  her;  thousands  of 
acres  of  the  sightly  lands  which  John  McDowell  owned  thus 
passed  into  the  hands  of  the  Bowyers. — Green. 

Samuel,  the  oldest  of  the  three  children  and  the  father 
of  Dr.  Ephraim  McDowell,  left  Pennsylvania,  the  place 
of  his  birth,  in  1737.  He  was  just  two  years  of  age.  Gross 
and  others  have  confused  Samuel  with  his  son  Ephraim, 
when  they  erroneously  referred  to  Ephraim  as  having 
reached  Danville  at  the  age  of  two  years. 

Samuel,  as  he  grew  up,  received  a  good  education  for 
those  times.  One  of  his  instructors,  who  is  referred  to  as 
"his  relative,  the  distinguished  Dr.  Archibald  Alexander," 
was  probably  the  Capt.  Archibald  Alexander,  who  was  the 
executor  of  Benjamin  Burden  and  the  first  sheriff  of  Rock- 
bridge County.  Capt.  Archibald  Alexander  was  born  in 
Ireland  in  the  year  1708  and  was  therefore  about  twenty- 
seven  years  of  age  when  Samuel  McDowell  was  born. 
It  is  not  unlikely  that  Capt.  Archibald  Alexander  has 
been  confused  with  his  grandson.  Rev.  Dr.  Archibald 
Alexander,  who  was  born  in  1772  and  in  the  latter  period 
of  his  life  occupied  a  chair  at  Princeton  University  until 
he  died  in  1851. 

At  the  age  of  18,  on  the  17th  day  of  January,  1754,  in 
what  was  then  Augusta  County,  Virginia,  Samuel  was 

3 


EPHRAiM  McDowell 

married  to  Miss  Mary  McClung,  daughter  of  John 
McClung  and  Elizabeth  Alexander.  Miss  McClung  was 
born  in  Ireland,  of  Scotch  parentage,  on  October  28,  1735, 
which  made  her  the  senior  of  her  husband  by  one  day. 
The  standing  and  the  influence  of  the  McClungs  was 
comparable  to  that  of  the  McDowells  and,  like  the  latter, 
they  and  their  progeny  were  destined  to  important  roles 
in  the  events  that  followed  that  period. 

Samuel  McDowell  and  his  wife  Mary  had  eleven  chil- 
dren born  to  them.  When  twenty  years  old  he  fought  in  the 
French  and  Indian  wars.  He  served  under  General  Wash- 
ington, and  was  present  at  Braddock's  Defeat.  In  1774 
he  served  as  captain  in  Dunmore's  Indian  War,  and  in 
the  battle  of  Point  Pleasant  was  an  aide-de-camp  to 
General  Isaac  Shelby,  who  afterwards  became  the  first 
governor  of  Kentucky.  Governor  Shelby's  daughter  later 
became  the  wife  of  McDowell's  son  Ephraim. 

Samuel  was  a  colonel  in  the  War  of  the  Revolution, 
and  with  his  regiment  served  under  General  Green  at  the 
battle  of  Guilford  Court  House,  and  throughout  Green's 
campaign  against  Cornwallis. 

Prior  to  the  Revolution,  Samuel  McDowell  and 
Thomas  Lewis  represented  Augusta  County  in  the  Con- 
vention of  1775  at  Williamsburg,  and  protested  against 
government  by  any  ministry  or  parliament  in  which  the 
people  were  not  represented.  They  were  delegated  to 
address  to  George  Washington,  Patrick  Henry,  Benjamin 
Harrison,  and  other  delegates  from  Virginia  in  the 
Continental  Congress,  a  letter  of  thanks  and  approval 
of  their  course.  In  1776  Samuel  McDowell  was  a  mem- 
ber of  the  Convention  held  at  Williamsburg,  Virginia, 
which  instructed  the  delegates  to  the  Continental 
Congress  to  declare  the  united  colonies  free  and  inde- 
pendent states. 

4 


ANCESTRY  OF  DR.  EPHRAIM  McDOWELL 

He  was  appointed  in  1782,  by  the  Virginia  Assembly, 
one  of  the  commissioners  to  settle  land  claims  in  the  dis- 
trict of  Kentucky.  Like  his  father  he  was  a  surveyor  and, 
in  1783,  he  came  with  his  family  over  the  Wilderness  Road 
and  took  up  his  residence  in  Fayette  County. 

In  that  year  the  District  of  Kentucky  was  formed  and 
the  first  district  court  was  opened  at  Harrodsburg,  with 
Samuel  McDowell,  George  Muter,  and  John  Floyd  as 
judges.    During  the  year  this  court  was  moved  to  Danville. 

According  to  Collins,  McDowell  was  made  president 
of  all  the  early  Kentucky  conventions,  nine  in  number, 
including  the  one  that  framed  the  Constitution  of  Ken- 
tucky. During  his  presidency,  in  1792,  Kentucky  was 
admitted  to  the  Union. 

In  religion  he  was  a  member  of  the  Presbyterian 
Church.  He  remained  upon  the  bench  until  a  few  years 
before  his  death,  and  was  known  as  Judge  McDowell, 
to  distinguish  him  from  one  of  his  sons,  Samuel.  After 
a  long  and  useful  life,  during  which  he  enjoyed  the  fullest 
measure  of  confidence  and  esteem  throughout  his  state, 
he  passed  away  September  25,  18 17,  at  the  age  of  eighty- 
two,  at  the  residence  of  his  son.  Col.  Joseph  McDowell, 
near  Danville,  Kentucky. 

But  to  obtain  a  true  idea  of  these  simple,  unpreten- 
tious, but  vigorous,  self-reliant,  and  courageous  people 
who  settled  on  Burden's  Grant  and  whose  descendants 
enacted  such  important  roles  in  the  early  development  of 
the  United  States,  especially  the  Middle  West  and  South, 
one  must  read  the  history  of  Augusta  County  as  depicted 
in  such  works  as  Peyton's  history  of  this  county,  where 
the  vigorous  Mary  McDowell  Greenlee's  deposition  in 
the  suit  of  Joseph  Burden,  plaintiff,  vs.  Alexander 
Cueton  and  others,  defendants,  is  referred  to  as  the 
cornerstone  of  the  county's  history.     She  is  described  in 

5 


EPHRAiM  McDowell 

this  work  as  a  witch,  and  one  of  her  witticisms,  when 
she  hospitably  pressed  more  food  on  a  member  of  her 
"quilting  party"  with  the  remark,  ''The  mare  that  does 
double  work  should  he  best  fed,"  has  become  part  of  the 
county's  history. 

It  is  difficult,  if  not  impossible,  to  comprehend  ade- 
quately not  alone  McDowell,  but  the  many  other  leading 
spirits  in  medicine,  law,  politics,  statesmanship,  on  the 
field  of  battle,  and  in  other  activities,  who  settled  in  Ken- 
tucky or  came  from  it  and  who  wielded  such  influence  in 
the  affairs  of  their  time,  without  a  clear  understanding 
of  the  origin  of  the  Kentuckians  and  of  the  peculiarities 
that  attended  the  early  development  of  the  state.  There- 
fore, a  little  light  upon  these  hitherto  more  or  less  neglected 
features  is  necessary  for  the  proper  understanding  of 
McDowell  and  his  contemporaries. 

The  states  of  the  Union  fall  into  three  groups :  first, 
those  that  were  directly  colonized  from  the  Old  World, 
such  as  Virginia  and  Massachusetts;  second,  those  that 
are  the  outgrowth  of  a  particular  colony,  such  as  Ken- 
tucky, the  daughter  of  Virginia;  and  third,  those  that 
are  the  result  of  a  mixed  immigration  from  various 
parts  of  the  old  world  and  from  other  states.  Of  these 
three  groups  the  second  is  the  smallest.  According  to 
Shaler,  "Kentucky  alone  is  fairly  to  be  called  the  child 
of  another  commonwealth." 

At  the  close  of  the  French  and  Indian  wars  before  the 
signing  of  the  treaty  of  Paris  on  February  lo,  1763,  through 
which  France  ceded  to  England  the  country  south  of  the 
lakes  and  east  of  the  Mississippi,  including  Canada,  Nova 
Scotia,  the  Island  of  Cape  Breton,  and  other  islands  in 
the  Gulf  and  River  of  St.  Lawrence,  thereby  restoring 
peace,  the  map  of  North  America  had  about  the  following 
appearance.    Mexico  included  all  of  the  wilderness  extend- 

6 


EARLY  DEVELOPMENT  OF  KENTUCKY 

ing  north  to  an  indefinite  boundary  in  Canada,  and  on  the 
west  to  the  Pacific  Ocean.  The  eastern  boundary  touched 
the  country  east  of  and  adjacent  to  the  Mississippi  River. 
All  this  territory,  together  with  Florida,  the  former 
through  a  secret  treaty,  was  under  the  dominion  of  Spain 
at  the  time  that  peace  was  declared.  Louisiana  was 
afterward  recovered  by  Napoleon  in  1800.  Before  this 
war  the  French  with  their  principal  southern  base  at  New 
Orleans  disputed  with  the  English  the  Mississippi  River 
and  the  adjacent  territory. 

The  English  occupied  the  coast  country  with  the  prin- 
cipal bases  in  Virginia  and  Massachusetts.  The  whole 
arrangement  has  been  compared  to  that  of  a  bow,  in 
which  the  English  occupation  of  the  coast  represented 
the  straight  string,  and  the  French  occupation  of  the 
interior  the  arched  bow,  with  the  lower  end  at  New  Orleans 
and  the  upper  end  at  Quebec.  Distinct  boundaries, 
in  the  present  sense,  there  were  none,  and  land  was 
gladly  given  in  abundance,  if  colonization  was  even 
remotely  forthcoming. 

In  fact  France  secretly  ceded  the  whole  of  Louisiana 
to  Spain,  to  prevent  it  from  falling  into  the  hands  of  the 
English  when  the  fortunes  of  war  looked  doubtful,  and 
it  was  accepted  by  Spain,  not  for  its  intrinsic  value,  since 
it  had  been  a  burden  and  an  expense  to  the  French  king, 
but  with  the  hope  of  using  Louisiana  as  a  buffer  state 
between  the  British  colonies  and  the  more  valuable 
province  of  Mexico. 

The  two  English  colonies  were  represented  by  Ply- 
mouth Rock  and  Jamestown,  Massachusetts  and  Virginia. 

The  New  England  colonists  were  largely  the  products 
of  the  Protestant  Revolution  through  which  they  had 
acquired  a  keen  intellectual  sense.  Unlike  the  Virginia 
colonists  they  were  more  given  to  recording  their  deeds, 

7 


EPHRAiM  McDowell 

which  makes  the  study  of  their  history  a  relatively  simple 
affair.  They  were  in  the  main  from  towns  and  were  trained 
more  to  the  arts  than  to  agriculture.  A  larger  proportion 
of  them  were  educated  men. 

The  Virginia  colony  was  at  the  outset  a  purely  com- 
mercial enterprise,  modeled  after  the  East  India  Company. 
CommerciaHsm  was  a  dominant  feature  of  England  and 
gold  hunger  and  land  hunger  were  the  passions  of  the  day. 

The  Virginia  settlement,  which  was  founded  in  1606, 
was  partially  a  penal  colony.  After  an  existence  of  18 
years,  this  proved  a  failure,  largely  because  of  the  worthless 
character    of  the  settlers. 

The  character  of  the  newcomer  in  the  succeeding 
Virginia  colony  is  not  so  clearly  established  as  is  the  char- 
acter of  the  newcomer  in  the  New  England  colony,  but 
from  all  information  the  conclusion  seems  justified  that 
"the  strength  of  the  immigration  consisted  of  the  yeoman 
or  'squire  class;  next  in  number  were  the  destitute  and 
semi-criminal  class,  who  were  sold  into  temporary  service 
to  pay  their  fines  and  the  cost  of  their  transportation  to 
the  colony;  and  for  a  while  least  in  numbers,  the  Africans, 
who  were  sold  into  permanent  slavery." — Shaler. 

Tobacco  was  their  chief  product,  and,  as  the  habit  of 
using  it  increased,  this  became  "America's  most  welcome 
gift  to  the  Old  World." 

Until  1725,  a  period  which  covered  a  little  more  than 
the  first  century  of  the  Virginia  settlement,  there  had 
come  from  Eng  and  and  lower  Scotland  a  steady  flow 
which  by  this  time  occupied  the  best  lands. 

Following  this,  there  was  a  decrease  until  about  1745 
when  there  was  a  large  exodus  of  Scotch  after  the  rebellion. 
Several  thousand  settled  beyond  the  Blue  Ridge  Moun- 
tains in  what  are  now  Amherst,  Augusta,  and  Rock- 
bridge Counties.     These  settlers  have  been  regarded  as 


EARLY  DEVELOPMENT  OF  KEUNCTKY 

the  most  important  contribution  to  Virginia,  not  only  in 
number,  but  in  point  of  independence,  vigor,  and  courage. 
They  and  their  children  were  to  a  large  extent  the  back- 
bone of  Virginia's  strength  in  the  Revolutionary  and  Civil 
Wars  and  later  they  constituted  the  major  element  in  the 
early  Kentucky  settlements. 

The  absorbing  passion  in  Virginia  was  not  for  religious 
discussion,  as  in  New  England,  but  for  possessing  land,  and 
delving  in  politics.  Having  come  rather  from  the  farm 
than  the  town  in  the  mother  country,  the  settlers  were 
less  inclined  to  intellectual  pursuits  and  more  to  out- 
door sports. 

The  population  fell  into  classes,  the  select  slave-owners 
and  the  "poor  whites."  This,  together  with  the  EngUsh 
principle  of  giving  the  real  estate  to  the  oldest  son,  soon 
developed  a  system  of  strong  families  that  controlled  the 
affairs  about  them.  They  looked  upon  the  whites,  who 
belonged  to  a  lower  class,  as  of  another  race.  A  certain 
amount  of  fast  living,  as  in  England,  was  considered  to 
be  the  mark  of  a  gentleman. 

All  of  this  was  in  a  measure  opposite  to  that  of  New 
England,  where  the  tendency  was  towards  democracy. 
The  sons  of  planters  were  educated  by  British  tutors  or 
sent  to  Europe.  The  children  of  the  poor  whites,  like 
their  parents,  remained  uneducated. 

In  the  first  150  years  of  her  existence,  Virginia  gave 
little  promise  of  great  statesmanship  or  political  liberties, 
so  that  when  the  Revolution  developed,  the  outburst  that 
marked  the  last  quarter  of  the  eighteenth  century,  it 
came  as  an  unexpected  awakening. 

Virginia  was  led  into  the  Revolution  in  1776  as  well 
as  into  the  Civil  War  through  the  influence  of  her  leading 
families,  rather  than  through  the  spontaneous  outburst 
of  the  masses  as  in  New  England. 

9 


EPHRAiM  McDowell 

She  was  the  most  populous  and  in  someways  the  richest. 
The  institution  of  slavery  made  it  possible  for  her  to  send 
a  large  part  of  her  white  men  into  the  field  when  they 
were  called  to  arms.  This,  together  with  her  love  of 
field  sports  and  the  training  through  the  French  War 
and  the  various  Indian  encounters,  eminently  fitted 
her  for  important  roles  in  the  Revolutionary  War,  as 
well  as  in  the  Civil  War.  She  stood  second  to  Massa- 
chusetts in  the  number  of  soldiers  she  furnished  during 
the  Revolution. 

To  this  sketch  of  the  settlers  of  Virginia,  who  were 
people  of  the  same  character  as  the  settlers  of  Kentucky, 
can  be  added  a  few  words  on  the  geographic  and  political 
development  of  Kentucky  as  a  necessary  prehminary  for 
a  full  understanding  of  the  early  Kentuckians. 

The  earliest  visits  to  Kentucky,  worthy  of  note,  were 
those  of  Daniel  Boone  and  his  party  in  1769  and  of  a 
company  headed  by  Colonel  James  Knox  in  1770.  In 
1773  surveyors  made  their  appearance  with  the  view  of 
dividing  the  land  near  the  western  waters  as  a  bounty  to 
the  Virginia  troops  who  served  in  the  French  and  Indian 
Wars.  In  1774  other  parties  and  surveyors  followed, 
among  them  James  Harrod,  who  erected  a  log  cabin  where 
Harrodsburg  stands  and  after  whom  the  town  was  named. 
The  following  year,  1775,  Richard  Henderson  purchased 
from  the  Cherokee  Indians,  in  violation  of  the  laws  of 
Virginia,  the  land  south  of  the  Kentucky  River,  and  with 
the  aid  of  Daniel  Boone,  built  the  Fort  of  Boonesboro. 
Transylvania  being  one  of  the  early  names  of  Kentucky, 
this  colony  was  called  the  colony  of  Transylvania.  Har- 
rodsburg and  Boonesboro  soon  became  the  attraction 
and  support  of  immigrants  to  Kentucky. 

In  1776  the  county  of  Kentucke  was  created  from  the 
county  of  Fincastle,  which  was  formerly  part  of  the  county 

10 


EARLY  DEVELOPMENT  OF  KENTUCKY 

of  Augusta.  Hitherto  Kentucky  was  merely  known  as 
the  western  fringe  of  the  Virginia  colony.  The  name 
"Kentucky"  is  from  the  Iroquois  word  "Kentake," 
meaning  prairie  or  meadowland.  Harrodsburg  was  desig- 
nated as  the  county  seat,  which  entitled  it  to  a  county 
court.  This  was  contemporaneous  with  the  Declaration 
of  Independence,  and  during  the  Revolution  immigration 
naturally  lagged. 

Toward  the  close  of  this  struggle,  interest  in  Ken- 
tucky became  more  acute;  and  from  1780  on  there  was  a 
steadily  increasing  activity  in  immigration  and  in  the 
location  of  land  warrants.  In  the  Kentucky  forests,  the 
surveyor's  outfit  and  the  rifle  were  inseparable.  With  the 
close  of  the  Revolution,  immigration  received  its  greatest 
impetus.  Everything  favored  this.  Men  were  long  out  of 
the  normal  pursuits  of  life,  with  their  places  filled  during 
the  Revolution.  The  land  in  Virginia  occupied  and  in  a 
measure  drained  of  its  productiveness,  the  spirit  of  adven- 
ture at  its  maximum,  nothing  was  more  natural,  notwith- 
standing the  Indian  and  other  perils,  than  for  these  de- 
tached people  to  turn  to  Kentucky  where  productive  land 
was  easily  obtainable.  Some  idea  of  the  strength  of  this 
immigration  may  be  had  from  the  fact  that  in  1840,  nearly 
sixty  years  after  the  close  of  the  Revolution,  the  pension 
returns  showed  that  there  were  about  nine  hundred  of 
these  veterans  still  living  in  Kentucky,  their  ages  varying 
from  70  to  109  years. 

With  this  exodus  came  the  McDowells.  Samuel 
McDowell,  in  1782,  was  appointed  commissioner  to  settle 
land  claims  which,  through  a  defective  and  unsystematic 
arrangement,  had  reached  a  distressingly  entangled  state. 
He  moved  with  his  family  to  Fayette  county  in  1783. 
By  this  time  the  county  of  Kentucky  was  sub-divided 
into  three  counties,  Fayette,  Lincoln  and  Jefferson.    The 

11 


EPHRAiM  McDowell 

first  district  court  was  then  established  with  Samuel 
McDowell  as  one  of  the  judges. 

Following  the  Revolution,  neither  the  Americans  nor 
the  British  fulfilled  all  the  terms  of  the  treaty  of  peace 
The  dereliction  on  the  part  of  the  British  consisted  of 
continuing  for  years  after  the  war  the  maintenance  of 
fortified  outposts  in  the  northwestern  part  of  American 
territory.  This  constituted  a  distinct  menace  for  Ken- 
tucky and  a  source  of  disturbance  between  the  British 
and  Indians  on  the  one  hand  and  the  Kentuckians  on  the 
other,  which  for  some  time  Congress  failed  to  remedy. 

Confronted  by  these  dangers  and  fearing  an  invasion. 
Colonel  Benjamin  Logan,  in  1784,  called  the  officers  of  the 
militia  and  other  citizens  together  at  Danville,  with  a 
view  to  arranging  defensive  measures  in  the  event  of 
an  attack. 

At  this  gathering  it  was  made  apparent  that  no  expedi- 
tions could  lawfully  be  carried  out  nor  resources  organized 
for  defense,  however  imminent  the  danger,  without  per- 
mission from  Richmond.  This  was  separated  from  Ken- 
tucky by  about  five  hundred  miles,  as  the  crow  flies,  and 
considerably  more  by  the  Wilderness  Road,  and  could 
be  reached  only  by  most  difficult  and  dangerous  travel. 
The  colony  awoke  to  the  necessity  of  a  government 
independent  of  Virginia,  and  with  this  end  in  view  a 
number  of  conventions  were  held  which  finally  accom- 
plished the  separation  from  Virginia,  and  the  admission 
in  1792  of  Kentucky  as  a  separate  state  in  the  union. 

The  historical  records  that  are  accessible  indicate  that 
the  conventions  were  not  devoid  of  excitement,  and  per- 
haps in  all  an  intense  order  of  politics  prevailed. 

The  separation  from  Virginia  and  the  Spanish  intrigue, 
a  political  move  of  an  international  nature,  that  involved 
the  free  navigation  of  the  Mississippi  River,  were  in  them- 

12 


EARLY  DEVELOPMENT  OF  KENTUCKY 

selves  quite  enough  to  maintain  a  maximum  of  tension, 
without  any  additional  feature.  The  separation  was 
marked  by  many  delays  and  disappointments  extending 
over  a  period  of  eight  years,  experiences  that  tried  the 
patience  of  the  Kentuckians  until  they  reached  the  point 
where  they  were  about  ready  to  effect  a  forcible  settle- 
ment not  only  from  Virginia,  but  from  the  Union  as  well. 
An  account  of  this  extreme  measure  involves  a  long  and 
intricate  story,  and  although  not  without  some  intrigue, 
the  separation  seemed  to  have  some  color  of  justification. 

According  to  Collins,  the  attorney  general  of  Ken- 
tucky, in  warning  the  chief  executive  of  Virginia  of  the 
Impending  separation  significantly  said,  "Congress  did  not 
seem  disposed  to  protect  them,  and  under  the  present  system  she 
could  not  exert  her  strength.''  This  led  to  the  establishment 
of  a  separate  state  government.  At  last,  in  December,  1790, 
President  Washington  strongly  recommended  the  admis- 
sion of  the  state  to  the  union  and  on  February  4, 1791,  the 
Act  was  passed,  the  admission  to  date  from  June  i,  1792. 

To  recapitulate,  the  Kentucky  spirit  was  the  offspring 
of  the  Revolution.  This  combative  spirit,  which  else- 
where was  overwhelmed,  lived  on  in  Kentucky,  fed  by 
tradition,  and  in  nearly  continuous  combat  to  the  time 
of  the  Civil  War.  The  surrender  of  Cornwallis  did  not 
spell  peace  for  the  Kentuckians.  These  settlers,  who  were 
largely  of  Scotch  origin,  came  mostly  from  that  part  of 
Virginia  west  of  the  Alleghany  Mountains.  It  required,  in 
the  first  place,  men  of  a  courageous  type  to  leave  England 
and  Scotland  and  settle  in  the  eastern  and  more  desirable 
part  of  Virginia,  but  when  it  came  to  pushing  into  an 
unknown  wilderness,  which  was  the  cockpit  of  warring 
Indian  tribes, — hence  the  sobriquet  of  the  "Dark  and 
Bloody  Ground," — it  is  needless  to  say  that  it  demanded 
a  venturesome  individual  with  courage  and  self-reliance  of 

13 


EPHRAiM  McDowell 

the  highest  order.  Not  alone  were  these  requirements 
indispensable,  to  begin  with,  but  the  very  environments 
in  which  they  were  thrust  could  not  fail  to  develop  still 
further  the  courage  and  self-reliance  that  made  their 
immigration  at  all  possible. 

It  was  entirely  natural,  therefore,  that  these  vigorous, 
unpretentious,  and  courageous  Scotch  settlers  should  de- 
velop into  leaders  in  every  domain  of  human  activity  in 
which  they  chanced  to  be  placed.  They  could  hardly 
escape  wielding  an  overwhelming  influence  in  Kentucky, 
primarily,  and  later  on  in  the  great  vigorous  West.  This 
West  in  the  main  developed  from  that  spur  or  wedge 
known  as  Kentucky,  whose  base  rested  against  the  Alle- 
ghany Mountains  and  whose  apex  pierced  that  unknown 
and  unbounded  wilderness  that  was  destined  within  a  little 
more  than  a  century  to  be  teeming  with  human  activity. 

A  careful  study  justifies  the  conclusion  that  Dr. 
Ephraim  McDowell  was  born  November  ii,  1771,  in 
that  portion  of  Virginia  called  Rockbridge  County. 

He  is  generally  referred  to  as  of  Scotch-Irish  stock; 
correctly  speaking,  he  was  born  in  the  colony  of  Virginia, 
under  the  British  flag,  of  Scotch  parentage.  He  was  a 
Virginian  by  birth  and  a  Kentuckian  by  adoption.  Both 
sides  of  his  house  were  of  Scotch  origin.  They  immigrated 
to  America  by  way  of  Ireland  after  some  residence  there. 
The  Scotch-Irish  reference  in  this,  as  in  most  other  in- 
stances where  it  is  employed,  is  somewhat  misleading, 
and  is  based  upon  the  residence  in  Ireland  and  not  upon 
any  mixture  of  Scotch  and  Irish  blood.  He  was  the  ninth 
of  eleven  children  and  the  sixth  son. 

Soon  after  his  birth,  events  of  a  momentous  nature 
began  shaping  themselves.  In  1776  the  Declaration  of 
Independence  was  signed  and  the  Revolution  was  in  full 
swing.     In  this  atmosphere  he  spent  his  boyhood  days, 

14 


HIS  BIRTH  AND  BOYHOOD 

only  to  be  transported  at  the  age  of  thirteen,  toward  the 
close  of  the  Revolution,  to  his  future  home  in  Kentucky. 
The  new  environment  was  perhaps  even  more  tense  and 
exciting  than  the  old.  Coupled  with  the  influence  of 
heredity,  no  doubt  these  conditions  contributed  largely 
toward  the  development  of  this  self-reliant  character, 
and  must  not  be  overlooked  in  our  understanding  of  the 
circumstances  that  led  up  to  and  made  possible  the  per- 
formance of  the  first  ovariotomy. 

Of  the  events  that  attended  his  life  prior  to  his  removal  to 
Kentucky,  we  know  nothing.  Most  likely,  aside  from  the 
excitement  of  the  times  and  life  on  the  frontier  portion  of  Vir- 
ginia, his  boyhood  days  were  spent  in  an  uneventful  manner. 

The  family  reached  Kentucky  in  1783,  where  his  father 
became  one  of  the  judges  of  the  First  District  Court, 
which  was  held  in  Harrodsburg.  It  is  said  that  owing  to 
the  unsuitability  of  the  building,  the  court  was  removed 
in  1784  to  Crow's  Station. 

This  led  to  the  development  of  Danville,  the  place  where 
McDowell  was  destined  to  spend  the  remainder  of  his  life. 

The  belief  is  that  Danville  was  laid  out  near  Crow's 
Station  in  178 1  by  Walker  Daniel,  who  was  killed  by  the 
Indians  three  years  later,  but  that  it  did  not  grow  in  im- 
portance until  the  removal  of  the  court  to  that  place  in 
1784.  It  was  the  first  capital  of  the  state.  During  the 
same  year  that  the  court  was  removed  to  Danville,  Col. 
Benjamin  Logan  called  his  militia  officers  together,  and  as 
a  result  came  the  conventions  already  referred  to.  Dan- 
ville was  selected  because  of  its  more  favorable  location 
on  the  Wilderness  Road,  over  which  more  immigrants 
traveled  than  by  the  Ohio  River,  since  the  former  was 
safer  from  attacks  by  the  Indians. 

In  1786  the  Pohtical  Club  came  into  existence.  This 
v/as  a  debating  society  composed  of  about  thirty  of  the 

IS 


EPHRAiM  McDowell 

"  Brightest  Spirits  of  the  Times,"  in  which  the  questions 
of  the  day,  especially  those  relating  to  the  development  of 
Kentucky,  were  threshed  out.  This  was  three  years 
after  the  arrival  of  the  McDowells.  The  club  continued 
in  existence  until  1790. 

That  Danville  had  the  reputation  at  this  time  of  being 
a  lively  place  in  addition  to  its  political  and  other  activi- 
ties is  attested  to  by  a  letter  dated  November  6,  1786, 
written  to  the  secretary  of  the  Political  Club,  in  which 
the  writer  said:  "How  do  you  like  the  life  you  lead  in 
Danville?  Are  you  drawn  into  excesses?  Keep  no  bad 
hours  or  company.  You  deserve  the  character  you  have 
of  a  prudent  man  for  your  years,  but  I  fear  that  the  levity 
of  the  place  may  lead  you  astray."  This  is  further  corro- 
borated by  the  records  of  the  First  District  Court,  which 
was  held  at  Harrodsburg,  about  ten  miles  distant  from 
Danville.  The  account  of  the  proceedings  throws  some 
light  upon  the  hfe  of  that  period  in  Kentucky.  This 
court,  of  which  Samuel  McDowell  was  one  of  the  judges, 
was  at  its  first  session  presented  by  the  grand  jury  with 
seventeen  offenders,  nine  of  whom  were  indicted  for 
keeping  tippling  houses,  and  eight  for  fornication  (Co //jwj). 

Some  idea  of  its  size  in  1790  may  be  obtained  from  a 
document  transmitted  by  Lord  Dorchester  to  Lord  Sidney 
in  England,  in  1789,  entitled  "Observations  Upon  the  Col- 
ony of  Kentucky."  "It  is  said  Danville,  the  seat  of  the  con- 
vention, and  considered  at  present  the  capital,  is  situated 
in  the  interior  country  upwards  of  eighty  miles  east  of  the 
Ohio  and  in  a  part  well  inhabited  and  improved.  It  con- 
tains upwards  of  150  homes  and  some  tolerable  good 
buildings."  A  comparison  with  other  towns  in  1790  shows 
that  Lexington  had  834  inhabitants,  Washington  462, 
Bardstown  216,  Louisville  350,  Danville  150.  Washing- 
ton, the  ancient  county  seat  of  Mason  (1788-1848),  was 

16 


HIS  BIRTH  AND  BOYHOOD 

located  three  and  one-half  miles  southwest  of  Maysville 
and  was  practically  its  forerunner.  Maysville  was  called 
Limestone  from  the  landing  at  Limestone  creek,  until 
1793.    {The  Political  Club.) 

In  an  educational  way  the  Transylvania  University, 
which  was  the  first  notable  institute  of  learning,  and  for 
many  years  the  foremost  one  west  of  the  Alleghany  Moun- 
tains, had  its  origin  in  Danville.  It  began  as  the  Transyl- 
vania Seminary.  The  first  meeting  of  the  trustees  was 
held  at  Crow's  Station,  near  Danville,  in  November,  1783. 
The  Seminary  was  opened  at  Danville  on  May  25,  1785, 
and  continued  there  until  1789,  when  it  was  removed  to 
Lexington  and  became  the  Transylvania  University. 
Centre  College,  which  for  many  years  has  been  Danville's 
principal  educational  factor,  began  in  18 19. 

No  doubt  Ephraim  McDowell  received  the  best  educa- 
tion that  those  early  times  and  frontier  conditions  afforded, 
an  education,  however,  according  to  our  present  standard, 
which  could  easily  be  termed  limited. 

Worley  and  James  have  been  referred  to  by  several 
as  having  conducted  a  school  at  Georgetown  and  later 
at  Bardstown,  and  as  having  been  among  his  teachers. 
He  is  also  spoken  of  as  having  attended  the  academy  at 
Lexington,  Va.  These  points,  although  of  no  special 
importance,  have  failed  in  verification. 

There  were  several  schools  in  existence  throughout 
Kentucky  about  this  period,  some  of  which  escaped 
historical  record.  In  1786  a  school  was  kept  by  Mr. 
Shackleford  in  Bardstown.  This  school  was  succeeded  by 
one  under  the  charge  of  Dr.  James  Priestly.  Many  of  the 
pupils  of  this  school  became  distinguished  in  after  life; 
among  them  were  FeHx  Grundy,  John  Rowan,  and  others. 

Upon  a  little  reflection,  however,  one  is  forced 
to  the  conclusion  that  the  pupils  of  these  schools  as  a 

2  17 


EPHRAiM  McDowell 

rule  added  more  lustre  to  the  schools,  than  the  schools 
added  either  lustre  or  learning  to  the  pupils;  and  that, 
after  all,  their  principal  education  came  from  the  train- 
ing they  acquired  through  the  times  and  the  environ- 
ment in  which  they  lived,  and  not  from  the  schools 
they  attended. 

McDowell  was  in  his  thirteenth  year  when  he  came  to 
Kentucky.  In  his  fifteenth  year  the  Transylvania  Semi- 
nary was  opened,  and  in  the  following  year  the  Political 
Club  came  into  existence  and  continued  until  1790.  This 
club,  for  its  time  and  in  itself,  constituted  a  liberal 
education.  In  1793  he  was  a  student  in  the  University  of 
Edinburgh  and,  for  two  or  three  years  prior  to  his  entrance 
in  Edinburgh,  he  studied  medicine  with  Dr.  Alexander 
Humphreys,  which  fairly  well  rounds  out  the  time  and 
leaves  but  little  if  any  opportunity  for  attendance  at 
school  in  other  parts  of  the  state.  In  his  nineteenth  year, 
if  not  a  little  before,  he  began  the  study  of  medicine  with 
Doctor  Humphreys,  of  Staunton,  Va.,  who  was  a  graduate 
of  the  University  of  Edinburgh. 

Doctor  Humphreys  had  at  the  same  time  for  a  pupil 
his  brother-in-law,  Samuel  Brown.  Like  McDowell,  and 
no  doubt  upon  the  advice  and  through  the  influence 
of  Doctor  Humphreys,  Brown  also  attended  the  Univer- 
sity of  Edinburgh. 

Of  Dr.  Alexander  Humphreys,  the  preceptor  of 
McDowell,  but  little  is  known.  From  all  indications  he 
was  the  most  prominent  practitioner  in  Staunton.  Aside 
from  his  standing  as  a  physician,  the  records  indicate  that 
he  held  the  oflice  of  commissioner,  and  in  addition  was 
one  of  the  first  trustees  of  the  Staunton  Academy,  a  high 
school  for  boys. 

Although  his  name  is  usually  spelled  Humphreys,  it  is 
not  uncommon  to  see  it  referred  to  as  Humphries. 

18 


THE  EDUCATION  OF  McDOWELL 

He  generally  had  students  about  his  "shop"  who 
were  being  initiated  into  the  mysteries  of  medicine,  as 
the  term  was  used. 

About  the  latter  part  of  1787  or  the  early  part  of  1788, 
the  mysterious  disappearance  from  Staunton  of  an 
Englishman,  and  the  subsequent  finding  in  a  cave  of  a 
bag  containing  the  remains  of  a  human  subject,  led  to 
unpleasant  and  troublesome  complications  for  Doctor 
Humphreys,  as  the  following  extract  from  the  Augusta 
County  records  indicate. 

August,  1789  (H  to  Z). 

Alexander  Humphreys  vs.  Michael  Graham — Slander. 
Writ,  nth  June,  1788.  On  June  9,  1788,  defendant  speaking 
of  and  concerning  William  Richardson  Watson,  who  was  sup- 
posed to  have  been  murdered,  and  of  the  bones  and  remains  of 
a  negro  found  in  a  cave  near  the  town  of  Staunton,  who  had 
been  buried  and  again  raised  by  the  students  studying  physic 
under  the  said  plaintiff  and  by  them  dissected,  said  plaintiff 
might  have  dissected  him,  the  said  William  Richardson  Watson, 
after  he  was  murdered,  and  then  he  might  have  put  him  in 
the  cave. 

Alexander  Humphreys  vs.  Samuel  Merritt — Libel  for  print- 
ing in  the  Winchester  Advertiser,  a  supposed  copy  of  an  inquest 
and  deposition  in  above  cause.  {Abstract from  the  Records  of  Au- 
gusta  County^  Virginia — Lockzvood.) 

April,  1790. 

Augusta  Sec. — Inquisition  at  Staunton  the  nineteenth  of 

May,  in  the  thirteenth  year  of  the  Commonwealth,  before  Joseph 

Bell,  gent,  one  of  the  coroners.    Upon  the  view  of  the  body  of  a 

person  unknown  in  a  cave,  discovered  by  Michael  Grove,  John 

Robeson,  Robert  Jacobs, dead  and  much  consumed  and 

upon  oaths  of  (the  jurors  who  sign  below) do  say  that  he 

was  a  white  man,  and  it  appears  to  them  from  circumstances  to 
be  the  body  of  a  certain  William  R.  Watson,  who  was  an  Inhabi- 
tant of  Staunton  about  November  last,  and  that  the  said  person 
has  been  murdered  wilfully  by  some  person  or  persons  unknown 
to  us.     (Signed)  Joseph  Bell,  coroner;  John  Griffin,  foreman; 

19 


EPHRAiM  McDowell 

Michael  Garber,  Samuel  Merritt,  William  McDowell,  Michael 
Si  vert,  Herman  Lovingood,  Owen  Owens,  James  McLaughlin, 
Abraham  Groves,  Francis  Huff,  John  Gordon,  Henry  Hauk, 
Robert  Astrop,  Hugh  McDowell,  Michael  Cawley,  James  Mc- 
Gongal,  Daniel  Donovan. 

Augusta  Sec. — On  the  9th  day  of  June,  1788,  came  before 
me  Joseph  Bell,  coroner,  for  said  county,  the  subscribers  being 
a  majority  of  the  within  jurors,  to  take  up  the  said  matter  from 
finding  further  testimony  was  to  be  had  in  the  matter,  caused 
to  come  before  us  Alexander  Humphreys  and  William  Wardlaw. 
After  being  sworn,  Alexander  Humphreys,  deposeth  and  sayeth 
that  about  March  last  his  students,  William  Wardlaw  and 
James  McPheeters,  did  take  from  the  place  of  burial  a  negro 
and  dissect  him  for  their  information  and  that  he  understood 
they  sewed  him  up  in  a  bag  and  put  him  in  the  cave  within 
mentioned, .  and  further  deposeth  that  after  a  negro  lays  some 
time  in  his  grave,  the  odds  cannot  be  known  between  him  and  a 
white  person  as  to  color.  Mr.  Wardlaw  deposeth  and  sayeth: 
That  about  March  court  last  him  and  James  McPheeters 
opened  a  negro  grave  and  took  therefrom  the  body  in  order  to 
dissect  the  same  for  their  insight  in  their  business,  and  after 
doing  so,  did  sew  him  up  in  a  crokass  bag  and  put  him  in  the 
cave  within  mentioned,  but  sayeth  when  they  took  him  up  he 
appeared  of  an  ash  color  and  that,  while  they  had  him  in  custody, 
his  color  did  not  change  as  well  as  he  recollects  and  further 
sayeth  not.  (Signed)  Joseph  Bell,  coroner;  Michael  Garber, 
Daniel  Donovan,  Hugh  McDowell,  Michael  Sivert,  Herman 
Lovingood,  Samuel  Merritt,  John  Garden,  James  Megongal, 
Francis  Huff,  Owen  Owens,  James  McGlachlin.  {Abstract  from 
Records  of  Augusta  County  ^Virginia. 

September,  1791  (A  to  C). 
Michael  Garber  vs.  Alexander  Humphreys — Malicious  pro- 
secution, slander  and  false  imprisonment.  Augusta,  6th,  April, 
1790,  etc.  {Abstract  from  the  Records  of  Augusta  County  y  Virginia.) 

It  is  possible  that  this  unpleasant  experience  influenced 
Doctor  Humphreys  in  his  removal  to  Kentucky  where  he 
spent  the  remainder  of  his  days. 

20 


CHAPTER  II 

LEAVES  FOR  EDINBURGH — ^AMERICAN  ASSOCIATES  IN  EDINBURGH 
VACATION    IN    SCOTLAND PROF.    A.    R.    SIMPSOn's    STUDY 

OF    McDowell    while    attending    the    university    of 

EDINBURGH BECOMES  A  PUPIL   OF  JOHN  BELL SKETCH 

OF  JOHN  BELL INFLUENCES  OF  THE  FRONTIER,  AND  DEPEND- 
ENCE OF  THE  FIRST  OVARIOTOMY  UPON  THE  FREEDOM  OF 
THE  FRONTIER. 

After  leaving  the  tutelage  of  his  preceptor,  McDowell 
seems  to  have  gone  direct  to  the  University  of  Edin- 
burgh, v/here  he  attended  the  sessions  of  1793  and  1794. 
His  immediate  companion  was  Samuel  Brown,  the  brother- 
in-law  of  his  preceptor.  The  others  who  attended  Edin- 
burgh at  the  same  time  were  Speed,  Brockenbrough, 
David  Hosack,  and  John  B.  Davidge,  nearly  all  of  whom 
left  distinct  evidences  of  the  activities  that  marked  their 
subsequent  careers.  Several,  while  in  Edinburgh,  seem 
to  have  resolved  to  found  a  medical  school  after  their 
return  to  America;  at  least  we  find  Hosack,  Brown,  and 
Davidge  In  the  roles  of  founders  of  medical  schools. 

Of  Speed  and  Brockenbrough,  very  little  information 
is  available,  save  that  the  former  accompanied  McDowell 
and  Brown  on  a  pedestrian  tour  of  Scotland  during  their 
vacation.  Samuel  Brown,  who  was  more  closely  asso- 
ciated with  McDowell  during  his  study  of  medicine  and 
at  Edinburgh  than  anyone  else,  was  the  son  of  a  Presby- 
terian minister.  He  has  been  referred  to  as  "the  elegant 
and  accomplished  professor  of  theory  and  practice  of 
medicine  in  the  Transylvania  University,"  and  from  birth 
enjoyed  practically  every  conceivable  advantage.  Birth, 
education,  family  influence,  opportunity,  personal  appear- 
ance, manners  were  his;  in  fact,  he  was  favored  in  every 
way.    After  settling  in  Lexington  on  his  return  from  Scot- 

21 


EPHRAiM  McDowell 

land,  Brown  and  Frederick  Ridgeley  became  the  first 
teachers  in  the  medical  departmentof  theTransylvania  Uni- 
versity. His  co-worker,  Ridgeley,  however,  was  of  an  en- 
tirely different  type.  If  Brown  was  *' the  elegant  and  accom- 
plished" Dr.  Samuel  Brown,  Ridgeley  was  the  vigorous 
and  forceful  Frederick  Ridgeley,  in  whose  '^ shop"  the 
best  of  the  earlier  practitioners  in  the  West  received  their 
inspiration  and  training,  among  them  Benjamin  W. 
Dudley,  the  most  successful  lithotomist  in  the  state,  and 
Walter  Brashear,  who  did  the  first  successful  hip-joint 
amputation  in  the  world.  He  was  the  surgeon-general 
of  Mad  Anthony  Wayne  in  his  Indian  Campaigns. 

In  fact,  Ridgeley's  whole  fife  was  crowded  with  action, 
romance,  and  adventure,  that  on  the  whole  have  been  as 
much  overlooked  in  history  as  Brown's  life  has  been  en- 
larged upon.  Brown  is  credited  with  being  the  first 
"American  Physician  to  practice  vaccination,"  an  honor 
that  Joseph  M.  Toner  (^^Contribution  to  the  Annals  of 
Medical  Progress  and  Education  in  the  United  States 
before  and  during  the  War  of  Independence'^)  accords 
to  Dr.  David  Ramsey  for  his  introduction  of  vaccinations 
into  South  Carolina  in  February,  1802.  But  posterity's 
interest  in  Brown  rests  largely  upon  an  unfortunate 
remark,  which  he  is  credited  with  making  after  his 
return  from  abroad.  On  a  certain  occasion  he  was 
asked  his  opinion  of  Dr.  Ephraim  McDowell,  where- 
upon he  is  said  to  have  replied,  "Doctor  McDowell 
went  to  Edinburgh  a  goose  and  returned  a  gander.'* 
Samuel  D.  Gross,  in  commenting  upon  this,  said,  "It 
is  much  to  be  regretted  that  we  have  not  more  birds  of 
the  same  kind." 

Another  of  McDowell's  Edinburgh  contemporaries 
was  David  Hosack,  who  went,  however,  not  as  a  student 
but  as  a  graduate,  having  received  his  degree  from  the 

22 


LEAVES  FOR  EDINBURGH 

University  of  Pennsylvania.  Hosack  was  a  tireless 
worker  and,  in  the  full  sense  of  the  term,  a  man  of  unusual 
ability.  He  was  an  intimate  friend  of  Alexander  Hamil- 
ton and  stood  by  his  side  on  that  memorable  morning 
when  the  duel  between  Hamilton  and  Aaron  Burr  was 
fought.  He  was  an  organizer  of  medical  schools,  the 
author  of  three  volumes  of  medical  essays,  aside  from 
biographies  and  other  essays,  and  an  excellent  botanist 
and  mineralogist,  in  addition  to  his  surgical  accomplish- 
ments. He  was  born  in  New  York  City  and  was  the  son 
of  a  Scotch  artillery  officer  serving  under  General  Sir 
Jeffrey  Amherst  at  the  re-taking  of  Louisburg.  He  studied 
at  Edinburgh  and  later  London.  On  his  return  he  held 
the  chair  of  botany  and  materia  medica  in  Columbia 
College  and  later  surgery  and  midwifery,  when  the  Col- 
lege of  Physicians  and  Surgeons  was  established,  but  later 
he  rehnquished  the  chair  of  surgery  for  that  of  theory  and 
practice  of  physic  and  clinical  medicine.  He  was  a  man 
of  charming  personality  and  had  a  large  circle  of  distin- 
guished friends.  He  died  of  apoplexy  after  attaining  his 
sixty-sixth  year. 

The  last  of  his  associates  abroad  was  John  Beale 
Davidge,  and  according  to  Lunsford  P.  Yandell,  Sr.,  it 
was  through  the  interest  of  Davidge  that  McDowell 
received  the  honorary  degree  from  the  University  of 
Maryland  in  1825.  This  seems  to  have  been  the  first 
degree  that  was  conferred  upon  him.  Davidge  was  one 
of  the  founders  of  the  University  of  Maryland.  He  was 
born  in  Annapolis,  the  son  of  an  ex-captain  in  the  British 
army.  On  his  voyage  abroad,  which  was  made  in  a  sailing 
vessel,  that, owing  to  rough  weather,  was  for  a  time  threat- 
ened with  sinking,  he  had  as  shipmates  Hosack,  Brocken- 
brough,  and  Troup,  all  of  whom  traveled  for  the  purpose 

of  study  abroad.     This  is  the  only  reference  to  Troup 

23 


EPHRAiM  McDowell 

discovered;  of  his  subsequent  movements  after  reaching 
Scotland  no  record  is  available.  Davidge  took  his  degree 
from  Glasgow  rather  than  Edinburgh  for  reasons  of 
economy.  This  seems  to  have  been  the  course  followed 
by  many  other  students  at  that  time. 

The  two  years  that  he  spent  in  Scotland  were  to 
McDowell  more  Hke  a  dream  than  a  reahty.  Coming  as 
he  did  from  a  primitive,  unsettled  country  to  the  home 
of  his  ancestors,  a  land  wildly  romantic,  teeming  with 
history,  and  picturesque  in  the  extreme,  with  the 
feeling  of  both  pleasant  and  profitable  times  ahead 
he  doubtless  felt  a  thrill  of  joy  after  the  mysterious 
sea  voyage,  then  so  protracted,  was  over  and  he  had  at 
last  reached  his  goal.  Edinburgh  was  at  that  time  con- 
sidered the  very  capstone  of  the  pyramid  of  medical  edu- 
cation. To  have  been  transported  from  one  extreme  to 
the  other  in  so  short  a  space  of  time,  could  hardly  fail  to 
be  strangely  fascinating  to  his  young  and  receptive  mind. 

That  he  was  not  long  in  attracting  the  attention  of 
his  classmates  is  attested  to  by  the  fact  that  he  was 
selected  by  them  to  defeat  a  boastful  Irishman  in  a  foot 
race.  A  race  was  arranged  between  McDowell  and  the 
Irishman  for  a  distance  of  sixty  yards  and  a  stake  of 
ten  guineas.  McDowell  purposely  allowed  himself  to 
be  defeated.  A  second  race  was  arranged  for  one 
hundred  guineas  and  an  increased  distance,  and  in  this 
the  Irishman  was  badly  beaten,  to  the  gratification  of 
the  students. 

His  vacations  were  evidently  as  enjoyable  as  his 
college  semesters  were  profitable.  With  his  friends, 
Brown  and  Speed,  the  delightful  Scotch  summers  were 
spent  in  pedestrian  tours  of  that  romantic  country,  visit- 
ing those  to  whom  they  had  letters,  and  occasionally 

24 


LEAVES  FOR  EDINBURGH 

meeting  one  of  their  family  connections.  With  a  change 
of  clothes  in  their  packs,  easy  consciences,  and  light 
hearts,  they  moved  about  amid  the  heather  and  the  high- 
lands like  three  musketeers  on  adventure  bent.  It  is 
said  that  when  they  reached  the  home  of  some  distin- 
guished person, 

*  *  *  they  always  hired  a  conveyance  and,  riding  up  in 
due  form  and  style,  were  received  accordingly.  They,  however, 
if  their  entertainment  was  to  their  liking,  soon  "let  the  cat  out 
of  the  wallet";  immediately  upon  which  all  formality  ceased, 
and  they  were  carried  about,  all  over  the  neighborhood,  either 
on  horseback  or  in  a  coach,  as  they  happened  to  fall  in  with  a 
commoner  or  a  "gig-man,"  and  exhibited  to  all  sorts  of  people 
as  gentlemen  from  the  extreme  backwoods  of  America.    (Gross.) 

In  his  university  career,  he  leaned  decidedly  toward 
the  more  practical  studies:  chemistry  in  the  beginning, 
and  anatomy  and  surgery  at  the  close.  Even  at  that 
time,  chemistry  was  an  excellent  companion  study  to 
anatomy  and  surgery,  in  that  it  tended  toward  directness, 
precision,  and  accuracy,  all  of  which  were  essential  in 
his  training  as  a  surgeon.  Anatomy  and  surgery  especi- 
ally appealed  to  him;  he  had  no  enthusiasm  for  internal 
medicine.  It  is  said  that  he  went  so  far  as  to  refer  to 
medicine  as  more  of  a  curse  than  a  blessing  to  the  human 
race,  while  surgery  he  characterized  as  "a  certain  branch 
of  the  healing  art."  It  was  only  natural  that  he  should 
think  so,  for  such  a  view  was  in  perfect  accord  with  the 
ideas  and  inclinations  of  one  who  hailed  from  the  edge 
of  the  frontier  where  deeds  instead  of  expresssions  were 
the  order  of  the  day. 

Prof.  A.  R.  Simpson  made  a  minute  study  of  Mc- 
Dowell's movements  while  at  Edinburgh.  The  results  of 
this  study  were  incorporated  in  his  lectures  at  the  Uni- 
versity of  Edinburgh  in  1887. 

25 


EPHRAiM  McDowell 

Some  of  the  views  that  resulted  from  this  inquiry 
are  as  follows: 

In  the  roll  of  Session  1792-93  I  find  that  Ephraim  McDowell 
has  inscribed  his  name. 

It  was  not  then  the  custom  for  the  entrant  to  give  his  place 
of  birth  and  residence.  So  he  has  simply  signed  his  name,  and 
opposite  the  signature  the  secretary  has  noted  that  he  is  entered 
to  study  chemistry. 

In  that  subject  he  would  come  under  the  inspiring  influence 
of  Joseph  Black,  and,  as  he  had  no  other  university  class  that 
session,  it  was  probably  during  it  that  he  studied  surgery  with 
John  Bell.  In  a  biographical  sketch  of  him  by  the  late  Professor 
Gross,  of  Philadelphia,  it  is  stated  very  confidently  that  it  was 
during  his  second  year  that  he  attended  the  lectures  of  that 
distinguished  extra-mural  teacher.  But,  when  he  matriculates 
for  the  second  time,  at  the  beginning  of  session  1793-94,  he  is 
entered  for  the  classes  of  anatomy  and  surgery  under  the  second 
Munro;  practice  of  medicine  under  James  Gregory;  and  botany 
under  Daniel  Rutherford ;  besides  the  clinical  prelections  in  the 
Royal  Infirmary. 

With  so  much  to  do  in  his  second  session,  and  so  little  in  the 
first  within  the  university,  it  seems  to  me  more  probable  that 
he  had  put  himself  under  Bell's  tuition  during  his  first  session 
here.    {Ridenhaugh.) 

In  connection  with  the  foregoing  extract,  the  writer 
begs  to  suggest  that  most  likely  the  version  of  Gross  is 
the  correct  one.  All  references  so  far  observed  place 
McDowell's  attendance  during  the  session  of  1793-94, 
except  that  of  Professor  Simpson,  who  refers  to  his  matric- 
ulation in  the  session  of  1792-93.  Since  this  is  taken  from 
the  matriculation  register,  it  seems  the  correct  one,  and, 
furthermore,  harmonizes  with  his  plans  of  touring  Scot- 
land between  sessions  and  his  return  to  begin  his  career 
in  1795. 

Therefore,  it  would  be  reasonable  to  conclude  that 
McDowell  matriculated  late  in  the  session  of  1792   as 

26 


LEAVES  FOR  EDINBURGH 

Professor  Simpson's  remarks  imply  when  he  says:  "But 
when  he  matriculated  for  the  second  time  at  the  Lcgm- 
ning  of  the  session  of  1793-94,"  and  that  he  deferred  his 
attendance  with  John  Bell,  as  Gross  suggests  until  the 
session  of  1793-94,  notwithstanding  his  other  studies. 
The  records  at  the  university  library  and  his  taking 
but  the  study  of  chemistry  would  strongly  suggest  that 
he  did  not  enter  until  late  in  February,  1793,  after  the 
session  was  about  half  over,  and  his  letter  to  his  brother- 
in-law,  A.  Reid,  dated  March  4,  1793,  written  soon  after 
his  arrival,  substantially  supports  this  view. 

Our  librarian  has  shown  me  the  library  day-book  of  the  time, 
from  which  it  appears  that  throughout  he  had  been  greatly 
interested  in  the  study  of  chemistry.  On  February  25,  1793, 
he  had  out  Hopson's  Chemistry;  On  March  nth,  Hoffman's 
Practice  of  Medicine;  March  25th,  Chaptal's  Chemistry;  April 
8th,  vol.  II,  of  the  same  work,  and  on  April  27th,  Hamilton  on 
Female  Complaints, 

During  the  summer  he  had  ceased  to  borrow  from  the 
library,  and  he  then  may  have  been  making  the  excursion 
through  Scotland,  described  by  Gross,  in  company  with 
two  of  his  compatriots,  one  of  whom  had  been  his  fellow 
apprentice  with  Doctor  Humphreys,  of  Staunton,  and  who 
enrolled  himself  in  the  same  two  sessions  with  McDowell  as 
Sam  Brown. 

On  September  25th  a  friend,  James  Cairns,  a  matriculate  of 
1793-94,  g^ts  Fourcroy's  Chemistry  for  him;  on  October  3d  he 
is  at  the  library  himself  for  Savary's  Letters  on  Egypt;  on  October 
15th  he  gets  a  volume  of  Chemical  Theses  and  two  volumes  of 
Medical  Commentaries^  and  the  last  entry  is  on  October  29, 
1 793  J  when  his  friend  Cairns  gets  for  him  Cullen's  Practice 
of  Physic. 

Among  the  readers  who  must  have  rubbed  shoulders  with 
him  at  the  librarian's  table  were  Henry  Brougham  and  Francis 
Horner;  among  the  students  who  sat  in  the  same  classes  with 
him  were  Monro  Tertius,  (Sir)  William  Newbigging,  and  John 
Bell's  youngest  brother,  (Sir)  Charles. 

27 


EPHRAiM  McDowell 

Gross  is  uncertain  as  to  whether  he  graduated  here 
or  not.  But  clearly  he  had  not  taken  out  the  requisite  courses  to 
qualify,  and  his  name  is  not  to  be  found  in  our  roll  of  gradu- 
ates.   {Ridenhaugh.) 

It  did  not  take  him  long  to  see  that  anatomy  and 
surgery,  If  not  better  taught,  were  at  least  more  inter- 
estingly taught  on  the  outside  of  the  university  by  John 
Bell  than  on  the  inside,  exalted  though  the  University 
of  Edinburgh  stood  as  a  medical  centre.  He  therefore, 
became  a  pupil  of  that  wonderful  man,  John  Bell.  His 
connection  with  Bell  was  a  fortunate  occurrence.  Bell 
could  hardly  have  failed  in  supplying  McDowell  with  an 
inspiration  that  most  likely  largely  sustained  him 
through  his  professional  career.  Bell  doubtless  forcibly 
depicted  the  hopeless  status  of  ovarian  tumors  as 
it  then  existed,  and  the  possibility  in  the  future  of 
a  relief  through  surgery,  as  it  had  been  cogently  pre- 
sented then  and  before  his  time  by  others  who  pre- 
ceded him.  McDowell  no  doubt  received  through  his 
teacher  a  complete  and  common-sense  summary  of  the 
entire  ovarian  question. 

It  now  remained  for  McDowell  to  escape  the  conser- 
vative, and  overshadowing  influence  of  the  university 
environment  into  just  such  a  free  atmosphere  as  his 
future  home  afforded.  Then,  the  opportunity  granted, 
he  could  be  relied  upon  to  supply  the  courage  and  the 
genius   necessary  for   the  accomplishment  of  the  deed. 

John  and  Charles  Bell  contributed  so  much,  especially 
for  that  period,  to  the  development  of  anatomy  and  sur- 
gery, that  It  Is  a  misfortune.  If  not  a  distinct  Injustice, 
that  so  little  Is  really  known  of  their  lives  and  their 
activities.  This  neglect  has  largely  been  overcome 
through  the  efforts  of  Dr.  Eugene  R.  Corson,  of  Savannah, 
Ga.    For  this   service  the  medical   profession   owes   to 

28 


SKETCH  OF  JOHN  BELL 

Doctor  Corson  a  debt  of  gratitude  for  his  splendid 
sketches  of  John  and  Charles  Bell. 

This  biographical  contribution  by  Doctor  Corson  upon 
the  Bells  has  made  possible  our  own  brief  outline  of  the 
life  of  this  eminent  man. 

John  Bell  was  born  in  Doun  Monteath,  Scotland,  on 
the  1 2th  day  of  May,  in  the  year  of  1763.  He  was  named 
after  his  grandfather,  Mr.  John  Bell,  a  minister  of  Glads- 
muir,  who  was  noted  for  his  impressive  eloquence  and 
determination,  qualities  that  later  became  manifest  to  a 
notable  degree  in  his  grandson.  He  preached  the  sermon 
upon  the  death  of  William  HI  before  the  General  Assembly 
of  the  Church  of  Scotland.  He  died  at  the  early  age  of 
thirty-two,  leaving  several  children,  of  whom  William 
became  most  prominent  through  the  important  roles 
enacted  by  his  four  distinguished  sons. 

The  independence  and  fearlessness  of  William  Bell  are 
best  illustrated  through  his  change  of  faith  from  the  Pres- 
byterian church  to  the  ministry  of  the  Episcopal  Church 
of  Scotland,  at  a  time  when  that  church  was  under  many 
restrictions  and  persecutions. 

His  first  wife  died  in  1750.  In  1757  he  married  Mar- 
garet Morice,  the  elder  daughter  of  an  Episcopal  clergy- 
man. Early  left  an  orphan,  she  was  educated  by  her 
grandfather.  Bishop  White,  afterward  Primus  of  Scotland. 
She  had  a  talent  for  drawing  which  she  transmitted  to 
her  children.  Of  these  six  children,  four  sons  rose  to 
great  distinction. 

Robert,  the  eldest  son,  became  an  advocate  and  pro- 
fessor of  conveyancing  to  the  Society  of  Writers  to  the 
Signet,  and  the  author  of  Scott's  Law  Dictionary  as  well 
as  several  other  works  on  the  laws  of  Scotland. 

George  Bell,  the  fourth  son,  was  a  distinguished  jurist 
and  professor  of  law  in  the  University  of  Edinburgh. 

29 


EPHRAiM  McDowell 

The  numerous  contributions  of  Charles,  the  youngest 
of  the  brothers,  upon  the  anatomy  and  physiology  of  the 
nervous  system  are  comparable  in  importance  to  the  dis- 
covery of  the  circulation  of  the  blood  by  Harvey. 

John  was  the  second  son.  Under  the  influence  of  his 
accomplished  mother  he  early  showed  signs  of  ability. 
He  attended  the  High  School  and  soon  thereafter  entered 
the  University.  He  began  the  study  of  medicine  as  a 
special  pupil  of  Mr.  Alexander  Wood,  a  prominent  sur- 
geon of  Edinburgh;  and  to  him  he  dedicated  the  first 
volume  of  his  "Anatomy  of  the  Human  Body."  Among 
his  teachers  in  the  university  were  Black,  CuUen,  and 
Monro,  Secundus. 

While  still  a  student  he  became  greatly  impressed  with 
the  importance  of  the  relationship  of  anatomy  to  surgery, 
which  importance,  strange  to  say,  had  been  largely  over- 
looked. This  made  such  an  impression  upon  Bell  that  he 
never  missed  an  opportunity  of  emphasizing  it  with  all 
the  earnestness  at  his  command.  In  fact,  we  believe  that 
this  same  attitude  toward  anatomy  which  McDowell  so 
strikingly  displayed  throughout  his  career  was  nothing  less 
than  a  reflex  from  John  Bell.    In  his  preface  Bell  writes : 

Of  all  the  lessons  which  a  young  man  entering  upon  our 
profession  needs  to  learn,  this  is  perhaps  the  first — that  he  should 
resist  the  fascinations  of  doctrine  and  hypotheses,  till  he  has 
won  the  privilege  of  such  studies  by  honest  labor,  and  a  faithful 
pursuit  of  real  and  useful  knowledge.  Of  this  knowledge,  anat- 
omy surely  forms  the  greatest  share.  Anatomy,  even  when  it 
is  neglected,  is  universally  acknowledged  to  be  the  very  basis 
of  all  medical  skill.  It  is  by  anatomy  that  the  physician  guesses 
at  the  seat,  or  causes,  or  consequences  of  any  internal  disease: 
without  anatomy,  the  surgeon  could  not  move  one  step  in  his 
great  operations:  and  those  theories  could  not  even  be  con- 
ceived which  so  often  usurp  the  place  of  that  very  science 
from  which  they  should  flow  as  probabilities  and  conjectures 
only,  drawn  from  its  store  of  facts. 

30 


SKETCH  OF  JOHN  BELL 

In  style  and  sentiment,  this  strongly  reminds  us  of 
McDowell's  remarks  on  "the  mechanical  surgeon"  in 
his  reply  to  the  criticism  of  Doctor  Henderson,  and 
we  involuntarily  think  of  Bell  when  we  read  Mc- 
Dowell's statement. 

His  date  of  graduation  has  been  given  as  1785  or 
1786.  In  the  latter  year  he  became  a  fellow  of  the  Royal 
College  of  Surgeons.  Before  beginning  his  career  as 
teacher  and  surgeon  he  made  an  extensive  tour  through 
Russia  and  northern  Europe. 

In  1790  there  was  built  for  him  a  lecture  theatre  in 
Surgeons  Square,  where  he  gave  a  course  of  lectures, 
carried  on  his  dissections,  and  formed  a  museum.  Until 
1804,  when  his  brother  Charles  went  to  London,  he  had 
his  help  as  demonstrator,  as  well  as  his  artistic  talents  in 
the  drawings  of  the  dissections,  and  in  the  plates  for  pub- 
lication. John  Bell  himself  was  no  mean  draftsman;  he 
etched  many  of  his  own  drawings,  although  in  this  he  was 
excelled  by  his  brother  Charles.  The  affection  which 
Charles  bore  his  older  brother  bordered  on  reverence. 
He  bowed  to  his  critical  judgment,  and  referred  to  him 
as  his  master. 

To  understand  John  Bell,  to  appreciate  his  character, 
and  to  comprehend  the  motive  of  his  life,  it  is  necessary 
to  keep  before  us  his  militant  nature  that  was  continually 
directed  against  error  and  falsity  on  the  one  hand,  and  in 
favor  of  truth  and  justice  on  the  other.  No  person,  insti- 
tution, or  state,  however  respected  or  time  honored,  was 
spared.  Error  and  falsity  wherever  they  existed  were 
attacked  and  exposed  with  all  the  earnestness  of  his  soul. 
Compromise  was  not  in  his  nature,  and  expediency  found  no 
place  in  his  activities,  for  least  of  all  did  he  spare  himself. 

He  would  accept  nothing  for  himself  unless  he  was 
clearly  entitled  thereto,  but  he  would  struggle  with  others 

31 


EPHRAiM  McDowell 

to  the  last  for  his  rights  and  his  principles.  He  was  a 
crusader  for  truth  in  general,  and  for  scientific  truths  in 
particular.  His  life  was  so  free  from  cant,  expediency, 
and  compromise,  that  he  was  continually  at  war  with 
these  forces  that  are  never  absent,  and  that  unfortu- 
nately are  the  undesirable,  and  seemingly  inseparable 
by-products  of  our  civilization.  He  was  of  the  material 
of  which  martyrs  are  made. 

But  he  could  well  afford  to  be  at  war  with  the  world 
over  what  he  believed  to  be  a  just  cause,  since  such  a  con- 
flict meant  peace  with  himself;  to  have  attempted  any 
other  course  would  mean  that  a  fiercer  conflict  would  be 
raging  within  than  the  one  that  was  in  progress  without. 
Measured  by  the  ordinary  standards  which  so  frequently 
recognize  success  and  advancement  as  the  chief  end  of  life, 
the  price  he  paid  was  by  many  considered  as  prohibitive, 
but,  measured  by  his  own  standard,  namely — ^that  no  suc- 
cess was  worthy  of  the  name  if  it  detracted  in  the  least 
from  his  own  self-respect — he  could  easily  aff'ord  to  con- 
tinue in  his  own  way,  however  prohibitive  the  cost 
appeared  to  others. 

The  University  of  Edinburgh,  which  was  founded  by 
James  VI. in  1582,  was  oneof  the  oldest  and  most  respected 
institutions  of  learning  then  in  existence.  Notwithstand- 
ing its  fame,  whether  through  age,  or  a  self-satisfied  feeling 
of  indiff'erence,  or  both,  it  had  drifted  into  customs  that 
were  not  entirely  to  its  credit.  It  is  only  necessary  to 
mention  two  of  these  to  illustrate  our  point.  The  chair 
of  surgery  was  held  by  the  Monro  family  in  regular 
dynastic  order  for  121  years,  and  it  has  been  intimated 
that  the  original  talent  quite  naturally  did  not  improve 
with  each  generation. 

Alexander  Monro,  Secundus,  was  the  teacher  of  sur- 
gery  during   the   attendance   of  McDowell.     The   first 

32 


SKETCH  OF  JOHN  BELL 

Alexander  Monro  had  been  a  pupil  of  Cheselden  and 
Boerhaave.  He  became  the  professor  of  surgery  in  1725 
and  he  was  also  the  founder  of  the  Royal  Infirmary. 

The  other  feature  that  was  discreditable  to  this  ven- 
erable institution  was  the  refusal  of  Charles  Bell's  pro- 
posal to  pay  the  hospital  one  hundred  pounds  a  year, 
and  to  transfer  to  it  the  museum  he  had  collected  on  the 
condition  that  he  be  "allowed  to  stand  by  the  bodies 
when  dissected  in  the  theatre  of  the  infirmary,  and  to 
make  notes  and  drawings  of  the  diseased  appearances." 

If  there  were  no  other  peculiarities  than  these,  they 
were  quite  enough  to  call  for  a  movement  of  reform;  but 
where  such  a  degree  of  nepotism  could  exist  side  by  side 
with  such  an  intolerant  element  of  jealousy,  it  is  safe  to 
say  that  the  faults  were  doubtless  so  evident  that  their 
exposure  became  a  perfectly  simple  matter. 

When  John  Bell  returned  from  his  tour  of  Russia,  pre- 
paratory to  the  beginning  of  his  career,  he  quite  naturally 
turned  to  his  alma  mater  as  a  proper  field  for  his  activities. 
But  the  projection  of  a  character  like  John  Bell  into 
an  environment  such  as  that  of  the  University  of  Edin- 
burgh at  that  time  was  not  unlike,  in  effect,  the  spraying 
of  a  fire  with  kerosene  oil,  with  the  hope  of  thereby  ex- 
tinguishing the  blaze.  The  effect  of  this  contact  was  not 
only  both  prompt  and  persistent,  but  as  it  progressed,  it 
rapidly  increased  in  intensity. 

In  1799,  the  gathering  storm  finally  broke.  In  that 
year  there  appeared  a  pamphlet  entitled  "Review  of  the 
Writings  of  John  Bell,  Esq.,  by  Jonathan  Dawplucker.'* 
This  was  issued  with  a  double  purpose:  first,  to  exonerate 
Monro  as  an  anatomist,  and  Benjamin  Bell  as  a  surgeon, 
from  the  unfavorable  criticism  of  John  Bell;  second,  to 
attempt  to  show  that  the  first  volume  of  John  Bell's 
Anatomy  was  a  plagiarism. 

3  33 


EPHRAiM  McDowell 

The  writer  of  this  anonymous  attack  was  Professor 
Gregory.  In  John  Bell's  "Letters  on  Professional  Char- 
acter, etc.,"  addressed  to  Gregory,  he  writes:  "With  all 
your  equivocations  about  Dawplucker,  I  well  knew  that 
under  that  title  you  threatened  my  character." 

John  Bell  replied  by  publishing  a  second  number  of 
the  Review,  also  under  the  name  of  Jonathan  Dawplucker, 
and  addressed  to  Benjamin  Bell  with  severe  reflections  on 
his  "System  of  Surgery."  He  vigorously  attacked  the 
stereotyped  methods  of  both  Monro  and  Benjamin 
Bell.  He  carried  the  students  with  him  and  Benjamin 
Bell's    "Sytem  of  Surgery"  lost  its  popularity. 

Dr.  James  Gregory,  the  professor  of  physics  in  the  univer- 
sity, who  besides  his  great  intellectual  brilliancy,  had  behind 
him  his  father's  reputation,  and  the  momentum  of  inherited 
power,  conceived  the  idea  of  excluding  the  younger  members 
of  the  Royal  College  of  Surgeons  from  practice  in  the  Royal 
Infirmary,  on  the  ground  that  the  patients  suffered  from  the 
constant  changes  in  treatment  in  the  monthly  rotation  of  the 
surgeons.  Bell  fought  the  measure  at  every  step.  He  appeared 
before  the  Board  of  the  Infirmary  and  produced  six  folio  books, 
filled  with  surgical  drawings  and  cases,  as  evidence  of  his 
system  of  teaching  and  his  need  of  clinical  material;  but 
they  turned  a  deaf  ear  to  him.  He  then  brought  the  ques- 
tion before  the  law  courts,  whether  they  had  the  power  to 
exclude  him,  and  it  was  decided  against  him.  Though  Gregory 
carried  his  point  he  was  subsequently  severely  censured  by 
the  Royal  College  of  Physicians  for  violations  of  truth  and 
unprofessional  conduct. 

Bell  was  appointed  by  the  Royal  College  of  Surgeons  of 
Edinburgh  to  reply  to  the  Memorial  of  Gregory,  which  he  did 
in  an  octavo  volume  entitled  "  An  Answer  for  the  Junior  Mem- 
bers of  the  Royal  College  of  Surgeons  of  Edinburgh  to  the 
Memorial  of  Dr.  James  Gregory,  on  the  Edinburgh  Infirmary." 
This  was  published  in  1800. 

But  the  controversy  did  not  end  here.  Ten  years  later  he 
published  a  work  entitled  "Letters  on  Professional  Character 

34 


SKETCH  OF  JOHN  BELL 

and  Manners,  on  the  Education  of  a  Surgeon,  and  the  Duties 
and  Qualifications  of  a  Physician,  addressed  to  James  Gregory, 
M.D.,  Edinburgh,  1810,  8vo." 

This  "Letters  on  Professional  Character  and  Manners,"  etc., 
is  indeed  a  most  remarkable  work,  636  pages  of  invective  and 
righteous  indignation,  an  expression  of  ten  years  of  bitter  con- 
troversy and  professional  strife.  Gregory  had  seen  fit  in  a 
quarto  volume  of  700  pages,  full  of  scurrility  and  personal  abuse, 
and  even  indecent  jokes,  to  attack  Bell  and  those  junior  surgeons 
whom  he  wished  excluded  from  the  Royal  Infirmary.  Copies 
of  this  work  he  had  distributed  gratis  among  friends  and 
patients.  He  had  even  employed  scurrilous  handbills  and 
posters  distributed  among  the  students  and  citizens  gener- 
ally. And  to  show  him  up  to  the  world  and  to  posterity 
Bell  saw  fit  to  write  this  book.  Oh,  the  pity  of  it,  that  he 
should  have  been  drawn  into  this  strife!  It  was  the  great 
mistake  of  his  life. 

Brilliant  as  Gregory  was  and  ever  ready  to  quote  his  Virgil 
and  Lucretius,  he  had  an  antagonist  equally  brilliant  to  answer 
him,  and  equally  ready  to  quote  from  Latin  literature  and 
English  literature,  and  to  meet  him  on  his  own  ground,  and 
with  his  own  weapons,  and  yet  to  be  always  the  gentleman. 
Though  Gregory  gained  his  point,  though  he  was  the  popular 
physician  of  the  day  and  the  brilliant  lecturer  in  the  university, 
and  though  fortune  and  prosperity  followed  him,  I  cannot 
accept  Lord  Cockburn's  rather  high  estimate  of  his  character. 
To  me  he  seems  mean  and  contemptible.  He  did  no  original 
work  in  science.  He  stands  out  a  good  example  of  mere  intel- 
lectual brilliancy,  as  we  use  that  term,  without  any  abiding 
productiveness,  or  really  contributing  to  anything.    (Corson.) 

From  all  this  it  Is  not  difficult  to  see  why  McDowell 
arrayed  himself  with  John  Bell,  nor  Is  It  difficult  to  under- 
stand the  influence  that  this  controversy  would  have 
upon  one  situated  as  McDowell  was  later  In  life. 

The  contributions  of  John  Bell,  however,  were  not  all 
of  a  polemic  nature. 

In  1793  when  he  was  at  the  age  of  thirty,  there  ap- 
peared the  first  volume  of  his  "Anatomy  of  the  Human 

35 


EPHRAiM  McDowell 

Body."  The  next  year  appeared  his  "Engravings  Ex- 
plaining the  Anatomy  of  the  Bones,  Muscles  and  Joints, 
Drawn  and  Explained  by  the  Author." 

Volume  II  on  the  "Heart  and  Arteries"  appeared  in 
1797.  The  third  volume  on  the  "Brain  and  Nerves,  the 
Organs  of  the  Senses  and  the  Viscera"  was  mostly  the 
work  of  his  brother  Charles.  In  1795,  appeared  his  "Dis- 
courses on  the  Nature  and  Cure  of  Wounds." 

His  first  volume  of  the  "Principles  of  Surgery"  ap- 
peared in  1 801.  The  second  volume:  "Containing  the 
Operations  of  Surgery,"  etc.,  was  issued  in  1806,  and  in 
the  next  year,  the  third  volume,  "Consultations  and 
Operations  on  the  More  Important  Surgical  Diseases." 
This  contained  a  "  Series  of  Cases  Calculated  to  Illustrate 
Chiefly  the  Doctrine  of  Tumors." 

Most  of  these  works  passed  through  two  or  more 
editions;  and  some  were  translated  and  published  in 
foreign  countries,  including  American  editions. 

From  this  very  brief  and  somewhat  incomplete  sum- 
mary of  the  works  of  John  Bell,  it  is  obvious  that  he  was 
a  man  of  tremendous  energy.  Of  course  he  was  assisted 
in  the  production,  as  well  as  the  illustrating,  of  these 
works  by  his  brother  Charles;  in  fact,  new  editions  of 
some  of  his  works  were  issued  by  Charles  Bell. 

Much  as  the  labors  of  John  Bell  represent,  they  are 
scarcely  comparable  to  the  work  of  his  younger  brother, 
either  in  scope  or  in  importance.  The  single  discovery 
of  the  respective  functions  of  the  anterior  and  posterior 
roots  of  the  spinal  nerves  places  Sir  Charles  Bell  in  a 
class  with  Harvey  and  his  discovery  of  the  circulation  of 
the  blood.  The  works  of  Sir  Charles  Bell  are  so  important 
and  so  numerous  that  space  does  not  permit  even  a  brief 
mention  of  their  titles. 

These   two   brothers   were   uncommonly   interesting 

36 


SKETCH  OF  JOHN  BELL 

characters,  geniuses,  and  incessant  workers.  Each  through 
his  brilliancy  aroused,  if  not  the  enmity,  at  least  the 
jealousy  and  the  intolerance  of  his  colleagues.  The  one 
combated  this  spirit  with  his  militancy,  the  other,  with 
an  attitude  of  non-resistance. 

Notwithstanding  the  kind,  simple,  open-hearted  unaf- 
fectedness  of  Sir  Charles  Bell,  his  early  experiences  in 
both  Edinburgh  and  London  were  hardly  less  bitter  than 
those  of  his  older  brother,  John. 

The  pathos  of  his  situation  and  the  tenderness  of  his 
nature,  as  well  as  the  meanness  of  those  about  him  during 
his  early  career  in  London,  are  strikingly  shown  in  the 
following  extract  from  his  later  writings. 

"These  days  of  unhappiness  and  suflFerIng  tended  greatly  to 
fortify  me,  so  that  nothing  afterwards  could  come  amiss;  noth- 
ing but  death  could  bring  me  to  a  condition  of  suffering  such  as 
I  then  endured. 

I  could  not  help  regretting  the  noble  fields  that  were  every- 
where around  me  for  exertion  of  my  profession,  and  which  I 
found  closed  against  me."    {The  Practitioner.  Vol.  Iviii.) 

John  and  Sir  Charles  Bell  strongly  remind  us  of  two 
other  brothers,  also  Scotchmen,  whose  names  are  perhaps 
the  best-known  of  any  English-speaking  members  of  their 
profession,  William  and  John  Hunter.  It  may  not  be 
amiss  to  say  here  that,  however  able  the  Hunters  were, 
especially  John,  the  author  believes  that  the  laurels  belong 
less  to  them  than  to  the  Bells,  who  with  each  year,  as  the 
knowledge  of  their  tremendous  joint  labors  and  the  results 
obtained  thereby  are  more  definitely  understood,  must 
continue  to  grow  in  importance  and  in  fame. 

In  1805,  John  Bell  married  Roslna,  daughter  of  a 
retired  physician.  Doctor  Congleton.  The  marriage  seems 
to  have  been  a  happy  one,  though  childless  Hke  that  of 
his  brother  Charles. 

37 


EPHRAiM  McDowell 

Although  his  income  was  large  he  seems  to  have  lived  in  a 
style  beyond  his  means.  He  lived  at  No.  9  George  Street,  at 
that  time  a  fashionable  part  of  the  new  town  of  Edinburgh. 

He  probably  entertained  much,  for  his  musical  parties 
were  celebrated.  His  social  gifts  were  many,  especially  his 
great  conversational  powers,  with  great  learning,  classical  and 
artistic,  and  much  general  information. 

He  is  described  as  "  below  the  middle  height,  of  good  figure, 
active  looking,  and  dressed  with  excellent  taste;  keen  and  pene- 
trating eyes  gave  effectiveness  to  his  regular  features,  so  that 
his  expression  was  of  a  most  highly  intellectual  type." 

Early  in  18 16  he  was  thrown  from  his  horse,  which  was  the 
beginning  of  ill  health  which  never  left  him.  In  18 17,  with  the 
hope  of  recovering  his  health  and  strength  he  started  with  his 
wife  for  Italy.  Even  at  the  beginning  of  his  journey,  before 
leaving  Paris,  he  was  evidently  aware  of  the  serious  nature  of 
his  illness,  for  he  had  jotted  down  In  his  note-book,  so  full  of 
fine  observations  on  art  and  architecture: 

"I  have  seen  much  of  the  disappointments  of  life.  I  shall 
not  feel  them  long.  Sickness  In  an  awful  and  sudden  form;  loss 
of  blood,  in  which  I  lay  sinking  for  many  hours,  with  the  feeling 
of  death  long  protracted,  when  I  felt  how  painful  it  was  not  to 
come  quite  to  life,  yet  not  to  die,  a  clamorous  dream!  tell  that 
in  no  long  time  that  must  happen,  which  was  lately  so  near." 

And  yet  with  this  consciousness  of  the  approaching  end, 
he  wrote  out,  with  the  same  interest  and  industry  he  had  written 
out  his  voluminous  clinical  records,  his  Impressions  of  travel, 
and  of  the  art  and  architecture  of  Italy  which  he  had  learned 
to  love  with  all  the  ardor  of  the  Southern  nature. 

He  died  in  Rome  on  April  15,  1820,  dropsical  and  In  great 
pain  and  suffering,  and  was  buried  in  the  Protestant  cemetery. 

Thus  lived  and  died  a  great  surgeon  and  a  great  man.  He 
stood  between  the  old  medicine  and  the  new;  he  saw  the  errors 
of  the  old,  and  helped  prepare  the  way  for  the  new.  He  was  a 
worthy  follower  of  John  Hunter,  for  he  taught  a  surgery  on  the 
basis  of  anatomy,  and  a  pathological  anatomy  above  all  mere 
theories  and  opinions  and  disease;  and  last  but  not  least,  he 
taught  a  deliverance  from  mere  authority  and  tradition  by 
honest  and  ever-vigilant  Investigation.   (  Corson.) 

In  1869  Sir  James  Y.  Simpson  visited  the  grave  and  had  the 
stone  repaired  as  a  mark  of  his  admiration.    {Corson.) 

38 


THE  FREEDOM  OF  THE  FRONTIER 

It  is  easy  to  understand  how  Bell  charmed  and  attract- 
ed McDowell,  and  many  of  the  other  university  students. 
Bell's^  courageous,  forceful  and  straight-forward  manner 
could  not  fail  to  impress  one  who  had  become  accustomed 
to  such  simplicity  and  directness.  If  we  add  to  this  his 
earnestness  as  a  teacher  and  his  ability  as  an  anatomist 
and  surgeon,  the  conclusion  is  irresistable  that  from  Bell, 
McDowell  received  an  inspiration  that  favorably  influ- 
enced him  throughout  his  entire  career. 

Bell  and  McDowell,  teacher  and  pupil,  represented 
the  Old  and  the  New  World.  Scotland  and  the  British 
Isles  are  better  understood,  or,  at  least,  their  histories  are 
more  carefully  and  clearly  recorded  than  that  of  the  New 
World,  whose  history  is  not  yet  so  fully  understood,  nor 
has  it  been  subjected  to  that  critical  analysis  to  which  the 
history  of  the  Old  World  has  been  exposed. 


With  John  Bell's  struggle  in  behalf  of  the  rights  of  the  junior  surgeons  the 
author  is  in  sympathetic  accord,  having  recently  taken  an  active  interest  in  a 
similar  movement  that  had  as  its  object  an  equitable  division  of  the  educational 
advantages  of  the  Louisville  City  Hospital,  a  municipal  institution.  This 
movement  was  opposed  by  the  University  of  Louisville,  also  a  municipal  insti- 
tution. Although  both  were  municipal  institutions  and  dependent  upon  the 
taxation  of  all,  the  educational  advantages  of  the  hospital  were  restricted  to 
the  minority,  to  the  detriment  of  the  major  portion  of  the  profession  and  their 
clientele  who  comprise  the  majority  of  the  citizens,  thus  multiplying  the  injustice. 
The  excuse  that  was  offered  for  this  unjust  and  selfish  arrangement  was  that  the 
interests  of  the  indigent  inmates  demanded  it.  Through  this  an  anomalous 
situation  arose,  a  physician  who  was  licensed  to  practice  upon  all  classes  within 
the  community  but  outside  of  the  hospital  was  considered  unfit  even  under 
proper  restrictions  to  practice  upon  the  community's  poor  within  the  hospital. 
The  denial  of  these  educational  advantages  to  the  majority  meant  a  denial  of  the 
opportunity  for  professional  improvement  on  their  part  and  its  corresponding 
influence  upon  the  services  rendered  their  clientele.  Either  these  educational 
advantages  should,  under  proper  rules,  be  granted  or  a  deduction  of  that  portion 
of  their  taxes  opportioned  to  the  hospital  should  be  accorded  to  those  who  are 
denied  its  advantages.  Any  other  course  would  mean  taxation  without  repres- 
entation, a  condition  that  was  directly  responsible  for  the  American  Revolution. 
The  remitted  taxes  might  be  used  to  assist  those  in  securing  elsewhere  that  post- 
graduate experience  that  is  denied  them  in  their  own  hospital.  Thus,  to  have 
the  cause  for  which  John  Bell  so  bravely  struggled  again  rear  its  head  more 
than  a  century  later  and  in  another  land  is  indeed,  a  testimonial  to  the  justice  of 
his  contention. 

39 


EPHRAiM  McDowell 

Since  the  achievements  of  McDowell  are  among  the 
most  important  of  the  contributions  of  the  New  World  to 
humanity  and  since  ovariotomy  is  so  distinctly  the  child 
of  the  frontier,  born  amid  its  simplicity,  its  coarseness,  its 
strength,  and  its  daring  deeds,  it  seems  but  proper  to  dwell 
more  definitely  upon  the  peculiarities  of  the  frontier  and  its 
influence  upon  the  evolution  of  the  most  vigorous  period  of 
the  New  World,  as  a  contrast  to  the  conditions  that  pre- 
vailed during  the  same  time  in  the  Old  World.  It  has  been 
so  customary  to  refer  to  the  hardships  of  the  frontier, 
which  were  mostly  misleading,  that  the  many  advantages 
of  the  frontier  have  in  the  past  been  almost  entirely  over- 
looked. If  such  a  criticism  is  applicable  to  our  own  shores, 
it  must  be  of  even  greater  importance  to  other  countries. 

The  history  of  the  United  States  is  largely  the  history 
of  its  frontiers.  Too  much  importance  cannot  be  attached 
to  this  fact,  and  Prof.  Frederick  Jackson  Turner;  Report 
American  Historical  Association^  iSgjy  has  rendered  a 
distinct  service  in  so  clearly  presenting  this  usually,  more 
or  less,  overlooked  phase  of  our  development.  The 
strength,  weakness,  virtue,  vice,  humor,  bravery,  ingen- 
iousness,  resourcefullness,  and,  in  fact,  all  the  peculiarities 
that  characterize  the  American  type,  are  mainly  the  re- 
sult of  the  influence  of  the  frontier.  Most  of  our  greatest 
leaders  in  every  field  of  activity  were  frontiersmen,  George 
Washington  was  such,  so  was  Andrew  Jackson  and  more 
strikingly  may  be  mentioned  the  immortal  rail  splitter, 
Abraham  Lincoln.  Theodore  Roosevelt,  was  the  last  of 
that  class. 

The  first  American  frontier  was  the  Atlantic  coast  line, 
and  this  at  the  same  time  served  as  the  frontier  of  Europe. 
It  was  this  frontier  that  soon  began  beckoning  to  the 
oppressed  of  Europe  to  come  to  the  land  of  opportunity 
and  freedom.    This  frontier  differed  from  a  European  fron- 

40 


THE  FREEDOM  OF  THE  FRONTIER 

tier  in  not  being  a  fortified  boundary  line  running  through 
dense  population.  It  had  on  its  one  side  the  great  Atlantic 
that  eflPectively  separated  it  from  the  struggles,  restrictions, 
and  oppressions  of  the  Old  World,  and  on  its  other  side 
was  that  unbounded  expanse  of  wilderness,  with  a  degree 
of  potential  wealth  that  surpassed  the  most  extravagant 
flights  of  human  imagination.  When  this  became  known 
the  oppressed  responded  promptly. 

When  those  plain,  virile  people  with  their  pent  up 
energies  came  to  this  land  of  freedom  and  opportunity, 
they  naturally  gravitated  to  where  the  most  opposite 
conditions  existed.  It  was  not  unlike  the  first  law  of 
motion,  action  and  re-action.  Therefore,  they  soon  found 
themselves  upon  the  frontier  which  was  always  the  line 
"of  most  rapid  and  eff'ective  Americanization."  The 
farther  inward  that  the  frontier  was  pushed,  the  farther 
it  became  removed  from  Europe,  and  the  more  it  became 
removed  from  Europe,  the  more  intensely  American  it  grew. 

Each  frontier  had  some  distinguishing  feature,  and 
each  frontier  made  its  corresponding  contribution  to  the 
American  character.   As  Turner  has  very  clearly  said : 

In  the  crucible  of  the  frontier  the  immigrants  were  Ameri- 
canized, liberated,  and  fused  into  a  mixed  race,  English  in  neither 
nationality  nor  characteristics. 

The  German  and  Scotch-Irish  elements  In  the  frontier  of  the 
South  were  only  less  great.  In  the  middle  of  the  present  cen- 
tury (19)  the  German  element  in  Wisconsin  was  already  so  con- 
siderable that  leading  publicists  looked  to  the  creation  of  a 
German  state  out  of  the  commonwealth  by  concentrating  their 
colonization.  Such  examples  teach  us  to  beware  of  misinter- 
preting the  fact  that  there  is  a  common  English  speech  in  Amer- 
ica into  a  belief  that  the  stock  is  also  English. 

The  Atlantic  frontier  was  composed  of  fisherman, 
fur-trader,   cattle  raiser,   miner,  and  farmer.     With  the 

41 


EPHRAiM  McDowell 

exception  of  the  fisherman  each  of  these  types  was  re- 
presented in  each  successive  frontier.  The  first  march  of 
the  frontier  occurred  in  the  seventeenth  century.  It 
moved  along  the  Atlantic  river  courses  to  the  ''fall  line," 
and  the  settled  area  was  the  tide  water  region.  By  the 
end  of  the  first  quarter  of  this  century  the  Scotch-Irish 
and  Palatine  Germans  reached  the  Shenandoah  Valley  and 
Piedmont  region  of  the  Carolinas.  About  the  close  of  the 
Revolution  the  frontier  was  pushed  over  the  Alleghanies 
into  Kentucky  and  Tennessee.  This  advance  carried  the 
McDowells  into  their  future  home.  From  Kentucky  and 
Tennessee  the  frontier  rapidly  moved,  in  successive  waves, 
westward  over  the  great  plains  to  and  beyond  the  Rocky 
Mountains. 

The  "fall  line"  was  the  frontier  of  the  seventeenth 
century;  the  Alleghanies,  that  of  the  eighteenth;  the  Mis- 
sissippi, the  first  quarter  of  the  nineteenth;  the  Missouri, 
that  of  the  middle  of  the  nineteenth,  and  the  Rockies  and 
beyond,  later  in  the  same  century.  California,  owing  to 
its  coastal  location,  and  the  discovery  of  gold,  became  a 
law  unto  itself.  So  there  occurred  the  trading  frontier, 
the  farming  frontier,  the  herding  frontier,  and  the  mining 
frontier.  Each  was  predominantly  of  one  kind  and  while 
blended  with  the  other  types  of  frontiersmen,  each  frontier 
was  influenced  by,  as  well  as  exerted  an  influence  upon  the 
forces  to  which  it  was  exposed.  As  they  moved  onward 
the  settled  rear  continued  to  grow  in  power,  wealth,  and 
importance. 

Soon  after  the  frontier  passed  the  Alleghanies,  a  con- 
scious West  with  its  more  intensely  American  character- 
istics arose  and  following  this  the  West  and  the  East  to  a 
certain  degree  grew  apart  from  each  other.  In  fact,  the 
East  attempted  to  curb  this  westward  expansion  with  its 
attending  independence.    Just  as  the  buffalo  trail  gave  way 

42 


THE  FREEDOM  OF  THE  FRONTIER 

to  the  Indian  trail,  this  in  turn  widened  into  roads,  and 
from  roads  evolved  the  turn  pikes,  and  from  turn  pikes  the 
railroads. 

Stand  at  Cumberland  Gap  and  watch  the  procession  of 
civilization,  marching  single  file — the  buffalo  following  the 
trail  to  the  salt  springs,  the  Indian,  the  fur-trader  and  hunter; 
the  cattle-raiser,  the  pioneer  farmer — and  the  frontier  has 
passed  by.  Stand  at  South  Pass  in  the  Rockies  a  century  later 
and  see  the  same  procession  with  wider  intervals  between. 

So  with  the  passing  of  the  frontier  with  its  character- 
istic freedom,  its  initiative,  and  daring  spirit  came  to  a 
close  the  first  and  what  many  may  consider  the  most 
vigorous  and  golden  period  of  our  evolution,  if  not  our 
existence.  We  pass  into  the  second  period  of  our  existence 
and  that  in  comparison  with  the  first  is  marked  by  the 
relative  absence  of  a  vast  region  of  potential  wealth,  at 
least,  within  our  original  territory,  and  instead  of  a  degree 
of  freedom  that  inspired  the  daring  and  that  led  to  the 
great  deeds  that  mark  our  first  period  we  see  a  restriction 
of  this  freedom. 

We  are  still  a  republic  in  name,  but  we  are  an  empire 
in  size  and  spirit.  From  our  former  beckoning  to  the 
oppressed  of  the  Old  World  to  seek  a  haven  of  freedom  and 
opportunity  in  the  New,  we  now  scrutinize  and  restrict 
them,  largely  owing  to  our  surplus  lands  being  occupied 
and  from  the  aims  of  the  Pilgrims,  who  literally  speaking 
camped  in  the  corn  fields  of  the  Indians,  and  who  only 
asked  the  privilege  of  being  permitted  to  live  their  lives 
after  their  conscience,  we  have  gradually  reached  the 
aims  common  to  all  empires. 


43 


CHAPTER  III 

Mcdowell  left  Edinburgh  without  his  degree — notable 
contemporaries  during  his  career transylvania  uni- 
versity  characteristics  of  his  practice his  price- 
less service  to  humanity. 

We  are  justified  in  the  belief  that  McDowell  left  Edin- 
burgh without  his  degree,  although  some  of  his  relatives 
claim  that  he  received  it.    Upon  this  point  Gross  writes: 

I  am  not  able  to  say,  from  the  facts  before  me,  whether 
Doctor  McDowell  was  graduated  at  Edinburgh  or  not.  His 
brother,  Colonel  McDowell,  states  that  he  was,  and  in  this  opin- 
ion he  is  joined  by  his  son,  as  well  as  by  his  nephew,  Dr.  William  A. 
McDowell.  My  belief  that  he  did  not  take  a  degree  in  Scotland, 
is  based  upon  three  facts :  first,  that  no  diploma  of  the  kind  has 
been  found  among  his  papers;  secondly,  that  Dr.  Samuel  Brown, 
his  classmate  at  Edinburgh,  solicited  him,  after  he  had  attained 
to  eminence  in  his  profession,  to  permit  him  and  his  friends  to 
draw  up  an  account  of  his  cases  of  ovariotomy,  in  Latin,  in 
order  that  it  might  be  sent  to  Edinburgh,  to  secure  him  a  degree; 
and  thirdly,  that  in  1825,  the  University  of  Maryland  conferred 
upon  him  the  honorary  degree  of  Doctor  of  Medicine,  a  cir- 
cumstance which  would  hardly  have  happened  had  he  been  a 
regular  graduate.  Be  this  as  it  may,  the  fact  that  he  was  or 
was  not  a  graduate  ought  not  in  the  slightest  manner,  to 
derogate  from  his  character  as  a  professional  man,  especially 
when  it  is  recollected  how  much  more  difficult  it  was  then  than 
it  is  now  to  obtain  a  degree  in  medical  schools. 

To  this  may  be  added  the  testimony  of  Prof.  Simpson, 
who  says :  *'  But  clearly  he  (McDowell)  had  not  taken  out 
the  requisite  courses  to  qualify,  and  his  name  is  not  to  be 
found  in  our  roll  of  graduates." 

Furthermore,  in  support  of  the  foregoing,  it  must  be 
remembered,  that  at  that  period,  and  for  some  time 
thereafter,  it  was  not  unusual  for  students  to  leave  their 

44 


McDowell  left  Edinburgh  without  degree 

colleges  before  receiving  their  degrees.  In  fact,  degrees 
then  did  not  mean  what  they  do  today,  and  the  attend- 
ance at  a  college  was  rather  to  secure  the  knowledge,  than 
to  secure  that  which,  in  a  manner,  represented  the  knowl- 
edge. In  McDowell's  case  the  element  of  expense,  in  all 
probability,  figured  even  more  than  it  did  in  his  friend 
Davidge's,  who  left  Edinburgh,  as  it  was  not  uncommon 
for  students  to  do,  to  take  his  degree  at  Glasgow,  since 
such  an  arrangement  was  more  economical. 

The  following  two  letters,  borrowed  from  the  biography 
written  by  his  granddaughter,  Mary  Young  Ridenbaugh, 
who  secured  them  from  Col.  J.  McD.  Alexander  of  Vir- 
ginia, are  interesting  not  alone  in  explaining  McDowell's 
financial  resources  while  at  Edinburgh,  but  in  throwing 
a  sidelight  upon  the  politics  and  the  economic  develop- 
ment of  Kentucky  at  that  period. 

The  first  was  from  his  father,  the  second  from  his 
brother-in-law,  Mr.  A.  Reid,  of  Rockbridge  County, 
Virginia.  Attention  Is  called  to  the  time  required  for 
McDowell's  letter,  which  was  dated  March  4,  1793,  to 
reach  his  brother-in-law,  who  replied  promptly  In  a  letter 
dated  August  25,  1793. 

Mercer  County,  State  of  Kentucky, 

February  10,  1793. 
Dear  Ephraim: 

I  have  not  heard  from  you  since  you  left  Rockbridge,  and 
am  very  anxious  to  hear  of  your  safe  arrival  in  Scotland.  I  can 
with  pleasure  inform  you  that  myself  and  all  your  friends  in 
Kentucky  are  well,  for  which  we  have  reason  to  be  thankful 
to  the  great  Author  of  our  Being.  We  have  not  anything  worth 
communicating  since  I  wrote  you  last,  when  you  were  in  Rock- 
bridge. Our  new  government  seems  to  go  on  middling  well, 
but  our  legislature  seems  very  parsimonious.  They  have  given 
our  government  £300  a  year,  and  the  judges  of  the  Court  of 
Appeals    £200.     The  secretary  £100  and  the  auditor  £100. 

45 


EPHRAiM  McDowell 

The  treasurer  £ioo  and  the  judges  of  the  court  of  Oyer  and 
Terminer  £30,  but  it  is  supposed  that  they  will  increase  their 
salaries  at  their  next  meeting;  but  I  rather  think  they  will  not, 
as  it  (is)  popularity  the  most  of  the  members  are  seeking,  and 
not  to  do  right  if  they  even  knew  it.  The  seat  of  government 
is  fixed  at  Frankfort,  Kentucky,  on  the  Kentucky  River,  where 
I  have  got  a  lot  or  two,  one  of  which  is  for  you,  if  you  live  to 
return,  and  choose  to  come  to  Kentucky,  which  I  wish  you  to  do. 

I  would  be  glad  to  hear  how  you  like  your  situation  there, 
and  how  long  you  think  it  will  be  necessary  for  you  to  stay,  for 
I  assure  you  it  will  be  very  hard  for  me  to  send  you  a  supply  of 
money.  But  I  will  endeavor  to  support  you  if  in  my  power, 
and  to  enable  you  to  bring  with  you  some  books,  and  a  quantity 
of  medicine  to  serve  you  some  time,  and  to  set  up  a  decent  shop. 
But  I  fear  I  will  not  be  able  to  send  you  money  sufficient.  But 
if  you  had  it  in  your  power  to  get  credit  for  some  of  which  you 
might  think  would  be  necessary,  I  will,  I  hope,  be  able  in  a 
short  time  after  your  return,  to  make  a  remittance  to  pay  for 
the  medicine.  Is  there  no  person  trading  to  Scotland  to  whom 
you  could  apply? 

But  I  need  say  no  more  on  the  subject  for  it  is  not  to  be 
expected  that  any  person  there  could  place  so  much  confidence 
in  you  as  to  give  you  credit  for  one  hundred  pounds  worth  of 
books  and  medicine,  and  you  must  try  to  do  the  best  you 
can,  and  steward  well  the  little  money  you  took  with  you. 
I  may  be  able  to  send  you  some,  which  may  be  about  fifty 
pounds.  I  will  send  you  more  if  you  need  it,  and  it  will  be  in 
my  power. 

Give  my  best  compliments  to  Mr.  Brown  and  Mr.  Watkins. 
Tell  Mr.  Brown  his  brother  James  is  well;  also  tell  Mr.  Watkins 
I  saw  his  father  not  long  since,  who  was  well  and  had  got  a 
letter  from  him.  Your  mother  seems  to  think  much  and  longs 
to  see  you  once  more  in  Kentucky.  You  know  of  my  small 
misfortune  in  my  speaking.  I  am  almost  now  persuaded  that 
what  Doctor  Humphreys  said  is  the  case  (to  wit),  a  swelling  in 
the  glands  about  the  root  of  the  tongue,  as  sometimes,  especially 
in  the  morning,  you  would  not  observe  it  to  hurt  my  speaking 
and  I  feel  no  difficulty,  and  after  some  times  in  the  day  it  grows 
worse.  Try  and  find  out  if  any  such  case  happens  in  the  course 
of  your  business  that  you  may  help  me.    Let  it  be  the  swelling 

46 


McDowell  left  Edinburgh  without  degree 

of  the  glands,  or  what  I  suspected,  a  touch  of  the  palsy,  I  only 
add  my  best  wishes  for  your  happiness,  and  believe  me  to  be 
your  affectionate  father,  Samuel  McDowell. 

N.B. — Your  mother  sends  her  blessings  to  you  and  hopes 
you  will  not  forget  your  duty  to  God,  who  has  always  been  so 
kind  to  you. 

Direction: 

Mr.  Ephraim  McDowell,  Student, 
Edinburgh, 
Scotland. 
Care  of  Col.  Gamble, 
Richmond. 

Rockbridge,  Virginia, 
Dear  Ephraim:  August  25,  1793. 

I  have  just  received  yours  dated  March  4th  last,  by  which 
I  was  agreeably  informed  of  your  safe  arrival  at  Edinburgh. 
The  opportunity  you  had  of  seeing  so  much  of  that  old  and  well- 
cultivated  country,  must  have  been  very  agreeable.  I  hope  it 
has  and  will  ease  your  mind  on  that  score  until  you  complete 
your  studies. 

I  hope  you  will  not  take  it  amiss  of  a  friend,  to  repeat  the 
necessity  of  your  diligence. 

Your  father  has,  I  expect,  written  you  that  he  means  to 
furnish  you  with  £300,  including  what  you  took  with  you  from 
home;  which,  from  the  statement  in  your  letter  of  the  necessary 
expenses,  I  am  afraid  will  scarcely  be  sufficient  without  very 
great  economy. 

I  have  had  letters  from  Kentucky  lately;  your  friends  are 
all  well  there.  Indians  are  still  very  troublesome  on  the  frontiers 
from  North  to  South.  A  treaty  has  been  proposed  by  the 
government,  I  suppose  more  with  a  view  of  quieting  the  minds 
of  members  who  are  averse  to  the  war,  than  an  expectation  of 
peace.  By  every  act  the  Indians  refuse  treating  on  any  other 
terms  than  making  the  Ohio  River  the  line,  which  never  will 
be  complied  with  by  the  Government.  The  President  ^  has 
called  on  the  State  of  Kentucky  for  fifteen  hundred  volunteers. 
It  is  said  they  (with  a  considerable  addition)  will  march  about 

^General  Washington. 

47 


EPHRAiM  McDowell 

the  first  of  next  month.  Report  says  that  the  commissioners 
who  were  sent  to  treat  with  the  Indians  are  made  prisoners  and 
not  permitted  to  return. 

We  have  agreeable  news  from  France  lately.  It  is  said  they 
have  beat  the  combined  armies,  both  by  sea  and  land,  and  I 
hope  will  continue  to  do  so  until  their  freedom  is  established; 
should  the  reverse  take  place  the  consequences  might  be  of  a 
serious  nature  to  America.  There  is  scarcely  a  doubt  that  the 
combined  powers  would  attempt  to  suppress  republicanism  here. 

Your  brother  Caleb  came  in  about  the  first  of  March;  he 
will  stay  with  me  perhaps  three  years  or  better  to  learn  the 
business  of  the  ofiice.  When  you  return  will  expect  you  to  take 
Rockbridge  in  your  road  to  Kentucky.  Doctor  Falconer  left  Lex- 
ington In  the  spring  and  returned  to  the  State  of  New  Jersey. 
He  sold  out  his  shop  of  medicine  to  Doctor  Campbell,  who 
succeeded  him  In  the  practice  and  is  in  pretty  good  esteem. 
Doctor  Falconer  is  expected  every  day  to  return.  He  intended 
settling  In  Buckingham  County  on  the  James  River. 

In  addition  to  the  medical  faculty  at  Staunton,  there  Is  a 
Doctor  Mcintosh,  who  by  a  pompous  advertisement,  ofi"ers  his 
services,  and  in  order  to  introduce  himself  he  says  he  studied 
at  Edinburgh  and  attended  the  lectures  of  Mr.  Monroe.  Your 
sister,  Caleb,  Sallie,  and  the  rest  of  the  family  join  me  in  com- 
pliments to  you.  I  am,  dear  Ephraim,  respectively  your  friend 
and  brother,  A.  Reid. 

Ephraim  McDowell, 

Edinburgh,  Scotland,  1793,  A.D. 

From  all  this  we  can  safely  assume  that  he  did  not 
receive  his  degree  from  Edinburgh,  and  this  likely  was 
due  in  part  to  his  lack  of  funds  on  the  one  hand,  and  pos- 
sibly even  more  so  to  the  idea  that  after  all  he  went  to 
Edinburgh,  not  so  much  to  secure  a  degree,  as  to  acquire 
a  sufficient  knowledge  of  medicine  to  enable  him  to  engage 
intelligently  in  the  practice  of  his  profession. 

He  returned  from  Edinburgh  in  1795  and  began  the 
practice  of  medicine  at  his  home  in  Danville,  which  was 
to  be  the  place  of  his  future  activities. 

48 


McDowell  left  Edinburgh  without  degree 

As  for  the  size  of  Danville,  in  Lord  Dorchester's  docu- 
ment to  Lord  Sidney  in  1789,  he  refers  to  Danville  as 
the  capital  and  as  "containing  upwards  of  one  hundred 
and  fifty  homes  and  some  tolerable  good  buildings." 
This  was  six  years  prior  to  McDowell's  return.  In  1850 
the  earliest  accessible  census  of  Boyle  County,  in  which 
Danville  is  located,  gave  it  9,116  inhabitants.  (Collins.) 
This  was  fifty-five  years  after  his  return;  so  we  may 
conclude  that  Danville  had  less  then  1,000  inhabitants 
when  he  began  his  career. 

Although  it  is  evident  that  he  settled  in  what  may  be 
called  a  small  country  town,  the  size  of  the  place  in  this 
instance  should  not  be  taken  as  a  criterion,  for  what  Dan- 
ville lacked  in  numbers,  it  more  than  counterbalanced  in 
the  importance,  and  the  character  of  its  inhabitants. 

While  no  longer  the  capital  of  the  state,  it  was  still, 
to  some  extent,  the  centre  in  which  the  politics  involving 
the  development  of  the  state  was  threshed  out;  and  for  a 
time  moreover  it  was  in  addition  a  hot  bed  of  international 
intrigue,  involving  British,  French,  and  Spanish  interests, 
on  which  the  permanency  of  the  newly  formed  govern- 
ment of  the  United  States  depended  more  than  is  gen- 
erally realized. 

The  Spanish  Intrigue,  involving  the  free  navigation  of 
the  Mississippi  River,  so  vital  to  the  very  existence  of 
Kentucky,  and  to  the  entire  West,  and  the  continued 
existence  of  fortified  British  outposts,  which  encouraged 
and  aided  the  hostile  Indians  in  their  depredation,  were 
matters  of  the  first  importance  and  continued  until  they 
were  settled  by  that  intrepid  but  neglected  leader.  Gen. 
George  Rogers  Clark. 

Few  of  us  at  the  present  time  have  but  the  slightest 
idea  of  the  importance  of  Kentucky's  role,  not  only  in 
shaping  the  development  of  the  West,  but  in  protecting 
4  49 


EPHRAiM  McDowell 

the  East.  It  acted  as  a  buffer  in  the  regions  beyond 
against  the  British  and  Indians,  who  were  always  on  the 
alert  for  the  opportunity  of  harassing  the  frontier  which 
Kentucky  represented,  if  not  of  pressing  onward  and 
endangering  the  newly  formed  government. 

Therefore  Danville,  at  that  time,  possessed  an  import- 
ance out  of  proportion  to  its  size,  and,  even  when  some 
of  its  importance  was  transferred  to  Lexington  and  Frank- 
fort, these  two  places  were  still  within  easy  reach  of  it 
even  in  those  days  of  primitive  travel.  Thus  McDowell 
began  his  career  in  an  active,  aggressive,  and  independent 
environment,  although  the  place  was  a  small  one  and  was 
located  in  a  wild  and  undeveloped  country,  in  which,  even 
as  late  as  1810,  one  year  after  he  performed  his  first 
ovariotomy,  there  was  passed  a  scalp  law  allowing  pay 
for  the  scalps  of  wolves. 

As  professional  contemporaries,  he  had  at  the  outset 
his  old  classmate,  Dr.  Samuel  Brown,  and  Dr.  Frederic 
Ridgeley,  both  of  whom  were  at  Lexington. 

Of  Brown  we  have  already  spoken,  but  Ridgeley  de- 
serves a  few  words  in  addition  to  the  former  reference. 

He  was  born  on  Elk  Ridge,  Anne  Arundel  County, 
Maryland,  May  25,  1757.  He  began  the  study  of  medi- 
cine in  his  seventeenth  year  and  in  his  nineteenth  was 
made  surgeon  to  a  corps  of  riflemen  raised  in  Virginia 
and  the  part  of  Maryland  adjoining.  With  these  he 
arrived  before  Boston  a  few  days  after  the  battle  of 
Bunker  Hill. 

He  followed  the  army  of  Washington  through  the 
trying  times  of  1776  and  1777.  He  studied  in  Philadelphia 
and  strengthened  his  already  existing  friendship  with 
Rush,  to  whom  he  bore,  in  appearance  and  manner,  a 
striking  resemblance.  This  friendship  lasted  through  life. 
While  he  was  ship-surgeon,  his  vessel  was  captured  after 

50 


NOTABLE  CONTEMPORARIES  OF  McDOWELL. 

a  severe  engagement  in  Chesapeake  Bay  and  he  escaped 
by  leaping  overboard  and  swimming  two  miles  to  shore. 
In  1790  he  came  to  Kentucky,  settling  in  Lexington. 
From  here  he  served  as  surgeon  in  several  Indian  cam- 
paigns. In  1794  he  was  appointed  Surgeon-General  to 
the  army  of  General  Anthony  Wayne.  After  that  cam- 
paign he  returned  to  Lexington  in  1799,  where  he 
with  Dr.  Samuel  Brown  became  the  first  teachers  in  the 
medical  department  of  the  Transylvania  University. 
He  held  the  chairs  of  materia  medica,  mid-wifery,  and 
the  practice  of  physic,  and  Brown  held  the  chairs  of 
chemistry,  anatomy,  and  surgery. 

Ridgely  was  probably  the  first  instructor  In  medicine 
west  of  the  Alleghany  Mountains.  Even  before  the  organ- 
ization of  the  medical  department  of  the  Transylvania 
University,  his  **jAo^"  was  thronged  with  pupils,  many 
of  whom  became  distinguished  practitioners  in  the  West. 
Prominent  among  the  number  were  Benjamin  Winslow 
Dudley  and  Walter  Brashear.  He  died  while  on  a  visit 
to  his  daughter  at  Dayton,  Ohio,  in  his  sixty-eighth  year. 

These  were  the  only  early  contemporaries  about  whom 
we  have  any  record;  later  came  Walter  Brashear,  who  in 
1806  performed  the  first  successful  hip-joint  amputation. 
This  was  three  years  before  McDowell's  first  ovariotomy. 
Brashear's  case  was  not  the  first  hip-joint  amputation, 
as  many  believe,  but  it  was  the  first  successful  one. 
Baron  Larrey  antedated  Brashear  by  seven  years.  Da- 
Costa  in  referring  to  this  in  his  sketch  of  Larrey  read 
before  the  Johns  Hopkins  Historical  Club,  February  12, 
1906,  says: 

He  tells  us  that  at  the  Siege  of  Acre  there  were  two  thousand 
wounded;  and  that  seventy  amputations  were  performed,  two 
of  them  being  hip-joint  amputations.  One  of  these  patients 
seemed  on  the  high  road  to  recovery,  when  he  took  the  plague 

51 


EPHRAiM  McDowell 

and  died  of  it.  The  other  one  died  of  shock.  At  the  time,  it 
was  considered  useless  to  attempt  hip-joint  amputation.  Larrey 
advocated  it,  in  spite  of  Pott's  view  "  that  it  is  a  bloody,  dread- 
ful, and  unjustifiable  procedure."  Larrey  was  seven  years 
ahead  of  Brashear  of  Kentucky  in  its  advocacy.  In  his  later 
campaigns,  he  twice  performed  this  operation  with  success, 
although  Brashear's  success  in  l8o6  antedated  Larrey's  by 
several  years. 

Brashear  came  from  Maryland.  He  was  born  in 
Prince  George  County  on  the  nth  day  of  February,  1776, 
and  came  with  the  tide  that  immigrated  to  Kentucky  at 
the  close  of  the  Revolutionary  War,  settling  near  Shep- 
herdsville.  He  attended  the  literary  department  of  the 
Transylvania  University.  In  1796  he  began  the  study  of 
medicine  under  Ridgeley,  but  attended  lectures  at  the 
University  of  Pennsylvania. 

In  1799  he  sailed  to  China  as  surgeon  to  the  ship 
Jane.  While  in  a  Chinese  port,  he  surprised  the  Celestials 
with  his  surgery,  amputated  a  woman's  breast,  and 
incidentally  acquired  the  art  of  clarifying  ginseng,  which 
helped  to  develop  his  latent  mercantile  tendencies  to  the 
detriment  of  his  professional  possibilities. 

The  hip-joint  amputation  also  a  product  of  the 
frontier  with  which  his  fame  is  associated  was  performed 
upon  a  male  negro  slave  seventeen  years  of  age,  belonging 
to  the  monks  of  St.  Joseph's  College  of  Bardstown. 
The  indication  for  the  operation  was  a  fracture  of  the 
thigh,  with  an  extensive  injury  to  the  soft  parts.  It  was 
performed  in  the  presence  of  Dr.  Burr  Harrison  and  Dr. 
John  Goodtell.  The  patient  recovered  and  lived  many 
years  thereafter. 

In  1 81 3  he  left  Bardstown  and  moved  to  Lexington, 

where  he  practiced  medicine  for   four  years.     In   1832 

he    moved  with    his    family    to    the    parish    of    Saint 

Mary,  Louisiana. 

52 


NOTABLE  CONTEMPORARIES  OF  McDOWELL 

He  was  a  many-sided  character,  doctor,  lawyer,  legis- 
lator, naturalist,  and  merchant.  The  many-sidedness  of 
his  character  was  no  doubt  largely  developed  by  his 
early  travels. 

It  is  common,  at  least  in  Kentucky,  to  hear  the  names 
of  Brashear  and  Dudley  mentioned  in  the  same  breath 
with  McDowell's,  as  though  they  really  were  his  contem- 
poraries. Strictly  speaking,  McDowell  and  Dudley,  in 
particular,  were  hardly  contemporaries,  and  the  explana- 
tion for  this  intimate  association  of  names  lies  in  the  fact 
that  they  were  all  men  of  large  calibre  and  'that  each  left 
a  distinct  impression  in  the  early  medical  history  of 
Kentucky — McDov/ell,  through  his  ovariotomy,  Brashear, 
through  his  hip-joint  amputation,  and  Dudley,  through 
his  record  as  a  lithotomist  and  his  many  years  of  activity 
as  teacher  in  the  medical  department  of  the  Transylvania 
University.  In  the  passage  of  time,  an  indifference  as  to 
the  exact  period  and  activities  of  each  has  arisen,  and 
thus  the  inaccurate  habit  of  associating  them  as  of  the 
same  date  and  continued  activity  has  grown. 

McDowell  began  his  career  in  1795,  whereas  Brashear's 
professional  career,  which  was  varied  and  broken,  in 
addition  to  his  activities  in  Bardstown,  consisted  mainly 
of  the  four  years  in  Lexington  between  181 3  and  1817. 
Dudley  was  but  ten  years  of  age  when  McDowell  began 
to  practice;  and  although  we  may  almost  say  that  he 
was  coming  on  the  stage  as  McDowell  was  preparing  to 
leave  it,  his  role  was  such  an  important  one  and  his  name 
so  intimately  linked  like  a  tv/in  star  to  that  of  McDowell's 
as  to  make  a  sketch  of  Dudley  somewhat  of  a  necessity. 

For  a  time  at  least  his  name  was  a  more  popular  one 
in  Kentucky  than  McDowell's,  and  if  we  omit  the  ovario- 
otomy  from  McDowell's  achievements,  it  was  deservedly 
so.     Dudley's  fame  rested  mainly  upon  his  success  as  a 

53 


EPHRAiM  McDowell 

lithotomist,  and  his  extensive  and  intimate  association, 
extending  over  a  period  of  thirty-five  years  with  medical 
men,  first,  as  their  teacher  while  in  the  medical  depart- 
ment of  the  Transylvania  University,  and  later,  as  their 
associate  and  consultant. 

Dudley  was  born  in  Spottsylvania  County,  Virginia, 
April  12,  1785.  His  father,  Ambrose  Dudley,  was  a 
captain  in  the  Revolutionary  War  and  later  a  Baptist 
minister  in  Kentucky.  He  received  such  education  as 
the  ordinary  schools  of  his  day  and  place  afforded.  He 
made  no  pretensions  to  Greek  or  Latin,  and  his  French 
he  acquired  while  abroad.  He  hardly  fulfilled  the  defini- 
tion of  a  student,  nor  had  he  any  literary  inclination. 

At  an  early  age  he  was  placed  under  the  tutelage  of 
Dr.  Frederick  Ridgeley,  who  in  all  probability  fired  the 
latent  qualities  of  Dudley,  much  as  John  Bell  made  his 
lasting  impression  upon  McDowell. 

In  the  session  of  1804  he  attended  the  University  of 
Pennsylvania  and  had  as  his  fellow  students  Daniel  Drake, 
John  Esten  Cooke,  and  William  H.  Richardson,  all  of 
whom  were  later  associated  with  him  as  teachers  in  Tran- 
sylvania. He  returned  to  Lexington  after  his  first  session 
in  the  University  of  Pennsylvania  and  during  the  spring 
and  summer  of  1805  engaged  in  the  practice  of  physic 
and  surgery  with  Dr.  James  Fishback,  who  acted  both  as 
preceptor  and  partner  to  Dudley.  Fishback,  who  held 
the  chair  of  professor  of  theory  and  practice  of  physic  in 
the  Transylvania  University  during  the  session  of  1805, 
is  characterized  as  "an  eloquent,  learned,  though  erratic 
divine,  an  able  writer,  a  physician  in  good  practice,  an 
influential  lawyer,  and  an  upright  citizen.'* 

In  the  fall  Dudley  resumed  his  studies  in  the  Uni- 
versity of  Pennsylvania,  receiving  his  degree  in  the  spring 
of  1806.     After  a  few  years  of  practice  at  Lexington,  in 

54 


NOTABLE  CONTEMPORARIES  OF  McDOWELL 

i8io,  he  descended  the  Ohio  River  in  a  flat  boat  to  New 
Orleans.  Here  he  purchased  a  cargo  of  flour  and  sailed 
on  a  prosperous  voyage  to  Gibraltar.  After  disposing  of 
part  of  his  cargo  at  Gibraltar  and  the  remainder  at  Lisbon, 
he  made  his  way  through  Spain  to  Paris.  He  spent  four 
years  studying  in  Europe,  principally  in  London  and 
Paris,  and  during  this  time  he  traveled  for  six  months  in 
Italy  and  Switzerland. 

In  his  manners  he  was  French,  in  his  methods  English. 
Larrey,  the  surgical  genius  of  the  Napoleonic  wars,  came 
in  for  a  large  share  of  Dudley's  admiration,  but  the 
hard  sense  of  the  English  appealed  more  strongly  to  him. 
Abernethy,  he  regarded  as  the  leading  surgeon  of  Europe, 
and  Sir  Astley  Cooper  was  his  ideal  operator.  He  re- 
turned to  Lexington  in  1814  a  member  of  the  Royal  College 
of  Surgeons.  Through  a  fire  in  the  London  custom  house, 
he  had  the  misfortune  of  losing  his  books,  instruments, 
and  a  cabinet  of  rare  minerals  {Collins).  In  1815,  the 
year  after  his  return,  he  was  made  professor  of  anatomy 
and  surgery  in  the  medical  department  of  the  Transylvania 
University.  These  chairs  he  held  until  1844,  after  which 
he  retained  only  that  of  surgery.  In  1850  he  resigned  and 
was  made  emeritus  professor. 

During  his  association  with  his  former  classmates  as 
teachers  in  Transylvania,  a  quarrel  arose  between  Drake 
and  Dudley  over  a  post-mortem  examination  of  an  Irish- 
man who  had  been  killed  in  a  fight.  On  account  of  this 
quarrel  and  Drake's  resignation,  sharp  pamphlets  passed 
between  them,  which  resulted  in  a  challenge  from  Dudley 
to  Drake,  that  was  vicariously  accepted  by  Drake's 
friend.  Dr.  Wm.  H.  Richardson.  In  the  duel,  Richardson  in 
the  first  fire  received  a  serious  wound  in  the  region  of  the 
groin.  Dudley  promptly  asked  permission  of  his  adversary 
to  assist  in  arresting  the  hemorrhage,  and  by  digital  pres- 

55 


EPHRAiM  McDowell 

sure  over  the  ilium  enabled  Richardson's  surgeon  success- 
fully to  apply  a  ligature.  This  magnanimity  on  the  part 
of  Dudley  resulted  in  a  reconciliation  with  Richardson 
and  the  estabhshment  of  a  permanent  friendship. 

He  is  credited  with  having  performed  lithotomy,  in 
the  course  of  his  life,  two  hundred  and  twenty-five  times, 
and  it  is  said  that  it  was  not  until  about  the  hundredth 
case  that  he  lost  a  patient.  He  performed  the  lateral 
operation,  his  favorite  instrument  being  the  gorget  in- 
vented by  Mr.  Cline,  of  London.  He  laid  great  stress 
upon  the  preparatory  treatment,  to  which  he  was  more 
incHned  to  attribute  his  success,  than  to  his  superior  skill. 
According  to  Gross,  he  was  the  first  to  Hgate  the  subclavian 
artery.  This  he  performed  in  1825  for  the  cure  of  an  axil- 
lary aneurysm,  which  was  described  as  "larger  than  a 
quart  pitcher."  In  1841  he  successfully  Hgated  the  com- 
mon carotid  artery.  All  this  was  prior  to  the  era  of  anaes- 
thetics. The  stress  he  laid  upon  the  use  of  boiled  and 
boiling  water  in  surgery  is  worthy  of  comment.  He  died 
at  his  suburban  home,  Fairlawn,  near  Lexington,  in  the 
eighty-fifth  year  of  his  age,  from  apoplexy,  after  an 
illness  of  two  hours. 

The  colleagues  with  whom  McDowell  was  more  imme- 
diately associated  while  in  practice  will  be  referred  to 
further  on. 

The  Transylvania  University  in  which  Dudley  enacted 
his  life's  role  v/as  established  at  Lexington  on  Decem- 
ber 22,  1798,  three  years  after  McDowell's  return  from 
abroad.  The  union  of  the  Transylvania  Seminary,  which 
was  located  near  Danville,  and  the  Kentucky  Academy, 
resulted  in  the  formation  of  the  Transylvania  University. 

This  was  the  first  university  west  of  the  Alleghany 
Mountains,  and  for  three-fourths  of  a  century  it  continued 
in  its  useful  educational  role.    The  history  of  the  medical 

56 


CHARACTERISTICS  OF  HIS  PRACTICE 

department,  we  may  say,  represents  the  history  of  Dud- 
ley's Hfe.  With  his  entrance  it  rose  and  prospered,  and 
with  his  exit  it  declined  and  faded  away.  The  records 
show  that  in  the  thirty-nine  years  of  the  existence  of  the 
medical  department  of  the  Transylvania  University,  it 
taught  6,456  pupils,  and  it  conferred  degrees  on  1,881 
{Filson  Club  Publication,  No  20). 

After  a  useful  and  enviable  career  the  Transylvania 
University  began  to  decline.  Thomas  Speed  (Filson  Club 
Publication  No.  11)  referring  to  its  decline,  says:  "It  was 
doomed,  however,  to  be  sacrificed  upon  the  inconsiderate 
altar  of  denominational  antagonisms.  Different  and 
opposing  religious  sects  struggled  for  its  control,  and  in 
the  conflict  the  university  was  consumed  by  the  fervor 
of  their  contest.  The  history  of  various  countries  is  full 
of  bad  deeds,  done  in  the  good  name  of  religion,  but  Ken- 
tucky has  witnessed  but  little  if  anything,  more  sad  than 
the  quarrels  of  her  religious  denominations  which  were  so 
disastrous  to  Transylvania  University." 

Although  McDowell  began  his  career  in  a  small  fron- 
tier town,  his  extensive  and  influential  connections,  the 
eclat  of  his  foreign  training,  and  the  absence  of  any  com- 
petition quickly  brought  results.  In  a  short  time  an 
extensive  practice  covering  what  then  was  the  entire 
Southwest  rapidly  sprang  up.  Ridgeley  and  Brown  were 
in  Lexington,  but  although  they  were  well  known  and  in 
high  standing,  they  could  hardly  be  counted  as  surgical 
competitors.  Brashear,  with  his  short  and  varied  activi- 
ties, came  later  and  likewise  did  not  come  in  competition 
with  McDowell.  Dudley,  it  might  be  said,  came  upon  the 
field  after  McDowell  had  completed  the  best  portion  of 
his  life's  work.  Therefore,  it  would  not  be  incorrect  to 
say  that  McDowell  was  and  for  some  time  continued  to 
be  the  first  surgeon  west  of  the  Alleghany  Mountains, 

57 


EPHRAiM  McDowell 

His  practice  extended  over  hundreds  of  miles  around, 
and  those  who  were  unable  to  call  upon  him  were  called 
upon  by  him.  This  was  in  the  beginning  before  the  days 
of  roads  or  the  stage  coach,  and  these  calls  were  made  on 
horseback  at  times  through  trackless  regions.  The  Indians 
were  still  with  us  and  the  wolves  were  plentiful  enough  to 
justify  the  enactment  of  a  scalp  law  intended  for  their 
extermination,  even  as  late  as  1810. 

Some  of  these  calls  meant  absence  from  home  in  the 
wilderness  for  a  week  or  more;  in  others,  a  surgical  opera- 
tion was  involved.  When  we  consider  that  all  of  this 
was  prior  to  the  use  of  anaesthetics,  and  compare  the 
dangers  and  difficulties,  the  crude  simplicity  and  the 
absence  of  all  trained  help,  that  marked  the  surgery  of 
his  career,  with  the  surgery  of  today,  with  all  of  its  com- 
forts, aids,  safeguards,  and  its  otherwise  wonderful  com- 
plexity of  detail,  we  almost  think  of  him  as  operating  and 
practicing  in  the  "stone  age"  of  surgery. 

He  performed  not  only  all  of  the  operations  known  to 
the  surgery  of  his  day,  but,  staged  as  his  activities  were 
in  this  crude,  wild,  but  picturesque  setting,  he  added, 
singly  and  alone,  through  his  ovariotomy,  infinitely  more 
to  the  art  of  surgery  during  the  short  space  of  his  career, 
than  all  of  the  rest  of  the  surgical  world  combined  added 
in  the  same  number  of  years,  during  the  same  period. 

When  he  gave  to  the  world  his  ovariotomy,  he  laid 
the  cornerstone  of  the  most  wonderful  and  fruitful  domain 
of  surgery  ever  known  to  the  human  mind. 

He  placed  in  the  diadem  of  the  art  and  science  of  surg- 
ery its  most  brilliant  gem  and  in  the  eons  of  time  becomes 
the  indirect  emancipator  of  countless  millions  of  human 
beings  from  protracted  suffering  and  premature  deaths. 
But  after  all  this  priceless  service,  he  practically  remains 
unknown  and  unhonored. 

58 


CHARACTERISTICS  OF  HIS  PRACTICE 

Up  to  1828,  two  years  prior  to  his  death,  he  performed 
thirty-two  Hthotomies  without  the  loss  of  a  hfe  (Gross). 
One  of  these  patients  was  no  less  a  person  than  James  K. 
Polk,  who  later  became  President  of  the  United  States 
States  and  who  ever  afterwards  held  in  grateful  remem- 
brance the  surgeon  who  made  his  career  a  possibility. 
The  operation  was  performed  in  1812. 

McDowell  practiced  the  lateral  operation  and  in  his 
early  career  opened  the  bladder  with  the  aid  of  a  gorget, 
but  later  opened  the  bladder  through  direct  dissection. 

Though  lithotomies  and  hernias  come  in  for  special 
mention,  he  undoubtedly  performed  all  the  operations  of 
emergency  or  otherwise  common  to  the  surgery  of  his 
day.  In  this  connection  it  is  unfortunate  that  so  little 
is  known  of  his  surgery,  for  no  doubt  many  interesting 
surgical  experiences,  encountered  in  what  we  would  now 
call  a  unique  surgical  environment,  are  forever  lost  to  us. 

Extravagant  claims  have  been  made  for  him  in  con- 
nection with  cases  of  Cesarean  section,  supposedly  per- 
formed in  this  country  and  abroad,  but  the  foundation 
for  these  claims  is  so  remote  that  we  dismiss  them  as  one 
of  the  several  myths  associated  with  his  life. 

He  made  it  a  rule  not  only  to  study  his  surgical  cases 
carefully  and  to  prepare  them  through  preliminary  treat- 
ment, but  moreover  to  rehearse  the  anatomy  and  steps 
of  the  operation,  as  well  as  to  drill  his  assistants  in  the 
roles  they  were  to  enact. 

By  preference  he  operated  on  Sundays,  a  practice  that 
was  in  a  measure  followed  by  some  of  his  successors  in 
early  Kentucky  surgery.  The  reason  given  by  some  for 
this  preference  is  that  he  liked  to  have  the  benefits  of 
the  prayers  of  the  church.  Although  McDowell  was 
undoubtedly  a  religious  person,  we  are  not  sure  that  this 
was  the  only  reason,  and  we  do  feel  that  in  the  case  of  his 

59 


EPHRAiM  McDowell 

followers  it  was  not  the  principal  reason,  if  it  came  in 
for  a  share  at  all.  What  seems  more  probable  is  that 
Sunday  was  given  the  preference  because  in  those  days 
surgical  operations  had  an  entirely  diflFerent  significance 
from  that  which  they  have  to-day,  and  because  it  was 
the  most  quiet  and  restful  day  of  the  week,  with  everyone 
more  or  less  disengaged. 

In  his  movements  he  was  deliberate  and  accurate, 
and  the  intensity  of  his  concentration  was  marked  by  the 
degree  with  which  he  perspired  when  operating,  even  in 
wintry  days.  To  his  patients  he  was  kind,  sympathetic, 
and  inspiring.  He  continued  to  cultivate  his  anatomy 
through  regular  and  systematic  dissections,  a  practice  not 
easily  carried  out  in  those  days  and  unfortunately  far 
too  much  neglected  in  these. 

This  practice  if  not  acquired  through  the  direct  influ- 
ence of  Bell,  who  dwelt  much  upon  its  importance,  was  no 
doubt  accentuated  by  it,  and  was  carefully  transmitted 
by  McDowell  to  his  pupils. 


60 


CHAPTER  IV 

THE    MEMORABLE    CASE    OF    MRS.    JANE    TODD    CRAWFORD — ^Mc- 

DOWELL's     DEFENSE     OF     HIS     CLAIMS ^ANALYSIS     OF     THE 

OPERATION LOCATING    THE    OPERATING    ROOM THE    TRA- 
DITION OF  THE  MOB HIS  RIGHTS  TO  THE  TITLE  OF  FATHER 

OF  OVARIOTOMY  AND   FOUNDER  OF  ABDOMINAL  SURGERY. 

On  December  13,  1809,  fourteen  years  after  he  began 
the  practice  of  medicine,  he  was  called  to  see  Mrs.  Jane 
Todd  Crawford,  the  wife  of  Thomas  Crawford.  She  Hved 
on  the  land  known  as  Motley's  Glen  on  the  waters  of 
Caney  Fork,  nine  miles  southeast  of  Greensburg  and 
about  sixty  miles  from  Danville.  This  is  the  woman  who 
for  a  century  has  been  referred  to  by  one  writer  or  another 
merely  as  Mrs.  Crawford. 

When  McDowell  and  his  memorable  patient  met,  it 
was  a  case  of  a  daring  man  and  a  courageous  woman 
coming  together  to  settle  a  problem;  and  when  two  such 
elements  meet,  action  always  results,  and  it  usually  ends 
in  the  solution  of  the  problem.  In  this  case  the  solution 
was  not  only  the  best  one,  but  the  full  extent  of  its 
benefits,  although  at  the  time  unknown  to  either  of 
them  was  destined  to  spread  and  enlarge  in  scope  through 
the  eons  of  time  to  the  benefit  of  numberless  milHons 
of  human  beings,  suffering  not  alone  from  ovarian 
tumors,  but  from  any  other  abdominal  condition  of  a 
surgical  nature. 

For  a  time  Mrs.  Crawford  was  thought  to  be  pregnant, 
but  as  she  had  far  exceeded  the  usual  period,  it  became  evi- 
dent that  some  other  condition  existed  and  McDowell 
was  sent  for. 

Accounts  exist,  giving  in  detail  a  recital  of  what  passed 
between  the  two;  but  what  really  occurred  is  mere  specu- 

61 


EPHRAiM  McDowell 

lation,  and,  barring  the  terse  statement  he  made  in  his 
published  report,  namely: — 

Having  never  seen  so  large  a  substance  extracted  nor  heard 
of  an  attempt  or  success  attending  any  operations  such  as  this 
required,  I  gave  to  this  unhappy  woman  information  of  her 
dangerous  situation.  She  appeared  willing  to  undergo  the 
ezperiment,  which  I  promised  to  perform  if  she  would  come 
to  Danville — 

will  in  all  probability  never  exactly  be  known. 

On  such  occasions  historians  are  absent;  moreover  in 
those  times  notes  were  seldom  kept  by  anyone,  and  from 
all  accounts  surgical  notes  by  McDowell,  never.  The 
operation  itself  was  not  recorded  until  seven  years  there- 
after, and  when  recorded,  its  text  was  such  as  to  excite 
suspicion.  The  only  conclusion  that  seems  at  all  admis- 
sible under  such  circumstances  is  that  after  the  examina- 
tion to  which  he  refers,  the  case  was  studied  from  every 
angle;  for  this  we  know  was  his  usual  method,  and  this 
case  being  an  entirely  new  departure  in  surgery,  he  doubt- 
less gave  it  additional  consideration. 

Realizing  to  a  greater  or  less  degree  the  increasing 
intensity  of  the  discussions,  that  by  this  time  had  been  in 
progress  for  fully  a  century,  upon  the  hopeless  nature  of 
this  condition,  and  the  possibiHty  of  reHef  only  through 
surgery,  after  satisfying  himself  of  the  correctness  of  his 
diagnosis  he  did  exactly  what  a  sensible  and  courageous 
man  would  be  expected  to  do. 

The  fact  could  no  longer  be  overlooked  that  further  dis- 
cussion v^ould  not  advance  the  status  of  ovariotomy  in  the 
least,  and  that  the  time  for  action  was  unmistakably  at  hand. 

But  here  is  where  McDowell's  good  fortune  in  living 
on  the  frontier  of  civilization,  in  an  unusually  free  en- 
vironment, and  amid  self-reliant  and  courageous  people, 
became  manifest. 

62 


MEMORABLE  CASE  OF  MRS.  JANE  TODD  CRAWFORD 

It  was  these  circumstances,  more  than  anything  else, 
that  made  it  possible  for  McDowell  to  aspire  to  the  honor 
of  being  the  first  ovariotomist.  Had  he  lived  under  the 
overpowering  shadow  of  a  famous  university,  it  is  safe 
to  say  that  he  would  never  have  had  this  distinction. 

To  feel  certain  of  this,  we  have  but  to  study  the  atti- 
tude of  John  Lizars,  also  a  pupil  of  Bell.  Lizars,  if  not  a 
better  surgeon  than  McDowell,  was  at  least,  through  his 
many  opportunities,  a  far  more  experienced  one,  and 
certainly  a  more  thoroughly  trained  anatomist.  He  was 
considered  one  of  the  ablest  men  in  Edinburgh,  and  so  well 
was  he  thought  of  that  Bell  made  him  his  substitute 
while  he  was  on  his  final  journey  to  Italy. 

Although  McDowell  had  sent  to  Bell  a  report  of  his 
three  cases,  all  of  which  were  successful,  and  this  report 
had  fallen  into  the  hands  of  Lizars,  owing  to  Bell's  absence, 
it  failed  to  move  him  to  action.  When  Lizars  received 
McDowell's  report,  seven  years  had  elapsed  since  the 
first  ovariotomy,  and  Lizars  allowed  seven  more  to  pass 
before  he  accorded  it  any  real  recognition.  This  is  the 
basis  for  the  belief  that  the  report  of  McDowell  made 
no  more  impression  upon  Lizars  than  it  made  upon  our 
own  Phillip  Syng  Physick. 

When  Lizars  finally  did  act,  although  he  was  a  more 
experienced  surgeon  and  a  better-trained  anatomist  than 
McDowell  with  all  the  surgical  facilities  which  that  period 
(fourteen  years  after  the  first  ovariotomy)  supplied,  and 
notwithstanding  the  added  assistance  of  his  university  col- 
leagues, he  not  only  failed  in  his  diagnosis,  but  floundered 
about  in  what  resulted  in  being  only  an  exploratory  incision . 
This  was  in  October  1823.  During  the  year  of  1825 
he  made  three  additional  attempts,  February  27,  March 
22,  and  April  24;  of  these,  one  died,  one  recovered,  and 
in  one  the  operation  was  abandoned. 

63 


EPHRAiM  McDowell 

The  effect  of  this  experience  was  such  that  ovariotomy 
was  abandoned  in  Scotland  for  twenty  years,  or  until 
1845,  when  it  was  revived  on  September  5th  of  that  year, 
by  Doctor  Handyside,  of  Edinburgh. 

From  this  it  is  obvious  that  these  so-called  advantages, 
which  Lizars  is  supposed  to  have  enjoyed,  were  no  more 
than  so  many  embarrassments,  from  which  McDowell 
through  his  location  in  the  wilderness  was  spared;  and 
mainly  because  he  was  spared  these  so-called  advantages 
and  this  overwhelming  conservatism,  he  became  the 
first  ovariotomist. 

Far  be  it  from  our  intention  to  underrate  either  the 
effort,  the  wisdom,  or  the  courage  that  was  necessary  on 
the  occasion  of  the  first  ovariotomy.  Even  after  McDowell 
had  repeated  the  experiment,  and  established  its  justifica- 
tion, he  was  called  upon  to  defend  his  claims.  What  we 
wish  to  emphasize  is  the  fact  that  McDowell's  frontier 
location  in  an  atmosphere  of  freedom  and  self-reliance, 
perhaps  seldom  equalled,  and  never  surpassed,  is  what 
made  the  operation  possible. 

It  was  the  very  existence  of  so-called  advantages  that 
embarrassed  Lizars,  and  made  his  efforts  so  lustreless  as 
compared  with  those  of  McDowell. 

To  speak  of  McDowell's  success  as  being  achieved 
notwithstanding  his  frontier  location,  and  in  the  absence 
of  the  supposed  advantages  that  existed  to  such  a  degree, 
for  example,  in  the  case  of  Lizars,  is  misleading,  in  that 
it  quite  naturally  creates  the  impression  that  he  was  at 
a  disadvantage,  whereas  the  opposite  more  correctly 
represents  the  situation.  The  supposed  advantages  that 
Lizars  enjoyed,  either  in  the  form  of  advice,  or  surgical 
appHances,  were  hardly  advantages  at  all;  in  the  first 
instance  the  very  abundance  of  the  advice  only  embar- 
rassed him,  and  as  for  surgical  accessories  or  refinements 

64 


MEMORABLE  CASE  OF  MRS.  JANE  TODD  CRAWFORD 

as  we  know  them  today,  they  simply  did  not  exist  at 
that  time.  The  difference  between  the  operating  appli- 
ances of  Lizars  and  those  of  McDowell,  were  after  all, 
practically  in  name  only.  This  mistaken  conception  of 
McDowell's  supposed  disadvantages  has  existed  for  more 
than  a  century,  and  loudly  calls  for  an  explanation  and 
a  correction. 

If  we  add  to  this  conservatism  of  the  old  world,  the 
egotism  of  humanity,  we  have  the  true  explanation  as  to 
why  the  operation  was  so  universally  condemned  by  the 
surgical  leaders  in  the  largest  cities  of  almost  every 
country,  a  condemnation  that  was  intense,  and  that  con- 
tinued as  such  over  an  unusually  long  period  of  time, 
even  after  the  country  doctors  of  these  various  countries 
had  recognized  and  successfully  performed  the  operation. 
Had  it  not  been  for  the  courage  of  McDowell,  and  the 
heroism  of  Mrs.  Crawford,  she  might  have  continued  to 
her  end  unrelieved  and  with  her  suffering  extending  over 
months  or  years  until  life  had  ebbed  away  under  a  painful 
degree  of  slowness.  But  what  is  of  greater  importance 
than  the  suffering  of  any  individual  is  that  the  establish- 
ment of  ovariotomy  might  in  consequence  thereof  have 
been  delayed  for  another  half  century  or  even  more. 

That  she  accepted  his  advice  and  relied  upon  his 
judgment  is  shown  by  the  promptness  with  which  she 
appeared  in  Danville  ready  for  "the  experiment,"  as  she 
expressed  it. 

The  difficulties  and  distress  attending  a  journey  made 
under  such  circumstances  are  doubtless  enough  in  them- 
selves to  justify  our  claims  to  her  possession  of  determina- 
tion and  courage  to  an  unusual  degree.  But  with  the  end- 
ing of  this  painful  journey,  the  real  ordeal  was  to  begin, 
and  although  it  was  ominous  enough  in  its  nature,  with 
rare  courage  and  fortitudes  she  unhesitatingly  played  her 

5  65 


EPHRAiM  McDowell 

part  in  carrying  out  the  momentous  experiment  which 
meant  so  much  for  her,  and  for  the  future  generations  of 
the  human  race.  She  made  the  journey  in  the  space  of  a 
few  days,  traveling  on  horseback,  resting  the  tumor  on 
the  horn  of  the  saddle. 

Her  grandson,  James  Crawford  Brown,  informs  us 
that  during  the  operation  she  occupied  herself  repeating 
the  Psalms. 

For  a  description  of  the  operation  we  rely  upon  the  plain, 
direct  and  original  statement  made  by  McDowell  himself. 

Some  years  after  the  operation,  an  attempt  was  made 
to  deprive  him  of  the  credit.  In  defense  of  his  claims,  he 
issued  a  card  in  1826  addressed  to  the  "Physicians  and 
surgeons  of  the  West  and  particularly  to  the  medical 
faculty  and  class  at  Lexington,"  meaning,  no  doubt, 
by  the  latter,  the  medical  department  of  the  Transyl- 
vania University. 

From  this  card,  which  now  seems  to  be  lost,  but  which 
did  not  escape  the  indefatigable  efforts  of  Gross,  when 
some  years  ago  he  interested  himself  in  the  subject, 
important  sidelights  adding  considerably  to  theasimple 
statement  made  -in  his  report  of  the  operation  are  ob- 
tained, namely: 

My  nephew,  Dr.  James  McDowell,  whom  I  had  brought  up, 
had  graduated  a  few  months  before  this  time,  in  Philadelphia, 
and  had  commenced  business  as  my  partner.  Being  in  delicate 
health  at  the  time,  it  was  my  intention  to  remove  to  the  coun- 
try in  the  spring,  or  so  soon  as  I  could  establish  my  nephew 
in  business. 

From  the  time  of  Mrs.  Crawford's  arrival,  he  had  made 
frequent  attempts  to  persuade  me  from  operating;  but,  finding 
my  determination  was  fixed,  he  agreed  to  be  present,  but  not 
until  the  morning  I  operated,  and  as  my  partner,  to  assist;  for 
should  the  patient  die,  the  responsibility  was  all  my  own;  should 
the  patient  live,  it  would  assist  him  in  his  outset  in  business. 

66 


MEMORABLE  CASE  OF  MRS.  JANE  TODD  CRAWFORD 

The  day  having  arrived,  and  the  patient  being  on  the  table, 
I  marked  with  a  pen  the  course  of  the  incision  to  be  made; 
desiring  him  to  make  the  external  opening,  which,  in  part,  he 
did;  I  then  took  the  knife,  and  completed  the  operation,  as 
stated  in  the  Medical  Repertory.  Although  the  termination 
of  this  case  was  most  flattering,  yet  I  was  more  ready  to  attri- 
bute it  to  accident  than  to  any  skill  or  judgment  of  my  own; 
but  it  emboldened  me  to  undertake  similar  cases;  and  not  until 
I  had  operated  three  times — all  of  which  were  successful — did 
I  publish  anything  on  the  subject.  I  then  thought  it  due  to 
my  own  reputation  and  to  suffering  humanity  to  throw  all  the 
light  which  I  possessed  upon  diseased  ovaria.  {Amer.  Med. 
Biography.') 

We  further  learn  that  Charles  McKinny,  a  private 
pupil  of  McDowell's,  and  a  Mrs.  Baker,  one  of  Mrs. 
Crawford's  female  attendants,  were  witnesses  of  the 
operation.  These  two,  together  with  Mrs.  Crawford 
herself,  issued  certificates  testifying  to  the  truth  of 
McDowell's  statement,  which  he  used  in  his  defense. 

Considered  in  the  light  of  the  present-day  surgery, 
the  features  of  the  operation  which  bear  emphasis   are: 

1st.  It  was  performed  without  the  aid  of  anaesthetics, 
antiseptics,  trained  help,  or  any  operative  accessories  save 
the  simplest  domestic  utensils. 

2nd.  The  incision  was  made  on  the  left  side  and  nine 
inches  in  length,  parallel  to  and  three  inches  from  "mus- 
culus  rectus  abdominus,'*  presumably  over  the  most 
prominent  part  of  the  tumor. 

3rd.  The  tumor  was  freely  movable,  with  a  pedicle  of 
sufficient  length  to  enable  ligation  before  the  evacuation 
of  its  contents,  or  the  delivery  of  the  sac. 

4th.  After  opening  the  abdomen,  the  successive  steps 
of  the  operation  were:  {a)  The  ligation  of  the  Fallopian 
tube  and  pedicle  near  the  uterus,  {h)  The  evacuation  of 
the  contents,  which  is  described  as  a  "dirty  gelatinous- 

67 


EPHRAiM  McDowell 

looking  substance."  (c)  The  extraction  and  removal  of 
the  solid  portion,  {d)  Replacing  the  intestines  that  es- 
caped with  the  opening  of  the  abdomen  and  remained 
exposed  until  the  removal  of  the  solid  portion.  (<?)  Drain- 
ing the  peritoneal  cavity  by  turning  her  on  her  side  to 
allow  the  escape  of  blood.  (/)  Closure  of  the  abdomen 
with  interrupted  sutures,  allowing  the  ligature  of  the 
pedicle  to  pass  out  at  the  lower  extremity  of  the  wound. 

5th.  Time  of  operation,  "about  twenty-five  minutes." 

6th.  The  tumor  was  partly  cystic  and  partly  solid,  the 
cystic  element  weighing  fifteen  pounds,  and  the  solid 
element  weighing  seven  and  one-half  pounds,  a  total  of 
twenty-two  and  one-half  pounds. 

7th.  In  five  days  he  "found  her  engaged  in  making 
up  her  bed,"  and  in  twenty-five  days  she  returned  home. 

In  view  of  the  fact  that  it  is  generally  believed, 
although  not  proved,  that  the  operation  was  performed  in 
his  home,  and  the  singular  phraseology  in  his  report,  "In 
five  days  I  visited  her,"  etc. — this  anomalous  statement 
was  seized  upon  by  his  early  detractors,  notably  Dr. 
James  Johnson,  editor  of  The  Lon.  Med.  Chir.  Rev.,  Jan- 
uary, 1825,  and  sarcastically  used  as  follows: 

Doctor  Mac  visited  the  patient  at  the  end  of  five  days, 
though  she  had  come  to  his  own  residence  to  have  the  opera- 
tion performed!  He  found  her  engaged  in  making  her  bed! 
She  soon  returned  to  her  native  place  quite  well.  {Credat 
Judceus,  non  ego.) 

Such  circumstances  excited  a  natural  curiosity,  as  to 
the  identity  of  the  particular  portion  of  his  residence 
where  the  operation  was  performed,  if  it  was  performed  at 
his  home  at  all,  and  how  such  a  seemingly  unusual  arrange- 
ment could  be  carried  out. 

Was  the  operation  really  performed  in  his  house,  or 
in  some  other  house  in  Danville  ?    Our  answer  based  upon 

68 


MEMORABLE  CASE  OF  MRS.  JANE  TODD  CRAWFORD 

circumstantial  evidence  is  that  it  was  in  his  house,  but 
positive  proofs  we  have  none.  Circumstantially  it  is  prac- 
tically impossible  to  reach  any  other  conclusion. 

Here  again  we  must  consider  surgery  as  it  was  practiced 
in  Danville  during  that  period,  as  compared  with  surgery 
as  it  is  practiced  in  the  present  day.  The  surgical  opera- 
tions were  comparatively  few  in  number,  and  relatively 
simple  in  character,  lithotomy,  operations  for  the  relief  of 
strangulated  hernias,  amputations,  and  tracheotomies 
being  the  prominent  ones  in  the  list.  Only  a  few  of  these 
fell  to  the  lot  of  the  most  prominent  surgeon  west  of  the 
Alleghany  Mountains,  during  his  entire  lifetime;  few  if 
judged  in  the  light  of  surgical  activities,  as  they  occur 
today,  in  the  life  of  a  surgeon  of  equal  rank.  Gross  places 
his  lithotomies  up  to  1828,  two  years  before  his  death 
at  32,  and  Jackson  places  them  at  22.  Take  the  higher 
figures,  and  they  would  represent  32  cases  in  about  the 
same  number  of  years,  although  lithotomies  were  perhaps 
the  most  important  and  frequent  of  the  operations  in 
the  surgery  of  that  time. 

Many  of  the  operations  he  performed  in  the  patients* 
homes;  some  of  which  were  more  or  less  remotely  situated 
from  Danville.  Certainly  this  would  apply  to  all  opera- 
tions of  an  emergency  character,  and  to  many,  if  not 
most  of  the  remaining  operations  that  were  not  in  the 
nature  of  an  emergency.  This  arrangement,  therefore, 
satisfactorily  reduces  the  total  number  of  patients  that 
came  to  Danville  and  submitted  to  an  operation  to  a  very 
small  number  each  year. 

In  those  times,  and  in  such  places  as  Danville,  infirm- 
aries did  not  exist  as  they  do  today.  Danville  was  a 
small  frontier  town,  that  was  still  growing  through  an 
influx  of  immigrants,  and  vacant  or  accessible  houses 
suitable  for  an  infirmary,  hardly  exist  under  such  condi- 

69 


EPHRAiM  McDowell 

tions,  nor  are  they  specially  built  for  such  a  purpose. 
Therefore  the  most  natural  course  for  him  to  take  was  to 
perform  these  few  operations  that  from  time  to  time 
presented  themselves  in  Danville  under  his  own  roof. 

If  this  is  a  reasonable  conclusion  in  the  case  of  lithot- 
omies, it  would  almost  be  the  inevitable  conclusion  in  the 
case  of  the  first  ovariotomy.  If  in  addition  to  the  fore- 
going facts  we  bear  in  mind  that,  in  his  conversations  with 
Mrs.  Crawford,  he  referred  to  the  step,  not  as  a  surgical 
procedure,  but  as  an  "experiment"  and  that  this  experi- 
ment of  a  most  daring  and  uncertain  nature  was  to  be 
performed  upon  a  woman  sixty  miles  from  her  home, 
representing  at  that  time  a  journey  of  two  or  three  days, 
it  is  inconceivable  how  anyone  could  think  of  McDowell's 
doing  otherwise  than  taking  his  patient  under  his  own 
roof  and  giving  her  the  same  attention  he  would  accord  a 
member  of  his  family,  even  though  he  were  not  the  kind 
and  sympathetic  man  he  is  represented  to  have  been. 

Kentucky  has  always  been  noted  for  her  hospitality, 
and  this  applied  far  more  to  the  Kentucky  of  the  early 
days,  than  to  the  Kentucky  of  the  present  time.  In  that 
primitive  period,  the  dangers,  and  difficulties  drew  the 
people  together.  Under  the  circumstances,  to  think  of 
McDowell's  not  receiving  this  woman  rather  as  his  guest 
than  as  his  patient,  would  be  in  direct  contradiction  to 
the  custom  that  prevailed  at  that  time,  and  a  reversal  of 
everything  favorable  that  had  been  said  of  him  as  a  man 
and  a  kind-hearted  medical  attendant. 

Gross  in  referring  to  the  operation  says:  "She  soon 
after  came  to  his  own  home  to  undergo  the  operation 
of  ovariotomy." 

Furthermore,  Dr.  Stanhope  P.  Breckinridge,  as  chair- 
man of  the  Committee  of  Arrangements,  in  his  address  of 
welcome  to  the  members  of  the  Kentucky  State  Medical 

70 


MEMORABLE  CASE  OF  MRS.  JANE  TODD  CRAWFORD 

Society,  reminded  them  /'You  are  now  within  a  few  hun- 
dred feet  of  the  office  where  Ephraim  McDowell  planned 
and  executed  the  operation  of  ovariotomy." 

This  was  on  the  occasion  of  the  thirteenth  meeting, 
held  in  Danville  in  1868,  and  eleven  years  later  Dr.  L.  S. 
McMurtry,  acting  in  a  similar  capacity,  used  the 
same  expression. 

If  it  were  not  that  doubts  have  arisen  as  to  where  he 
performed  the  operation,  this  direct  explanation,  as  well 
as  indirect  explanations  made  further  on,  would  hardly 
seem  justifiable. 

After  satisfying  ourselves  that  this  is  the  house  in 
which  the  first  ovariotomy  was  performed,  the  next  ques- 
tions are  in  which  part  of  the  house  did  this  memorable 
operation  take  place,  and  what  is  the  explanation  of  the 
singular  phraseology  in  his  report  ? 

If  we  study  the  construction  of  the  McDowell  home, 
especially  the  rear  view,  it  is  evident  from  the  differences  in 
the  architecture,  and  the  materials  represented  in  its  con- 
struction, that  it  was  built  in  at  least  two  distinct  periods. 

These  differences  can  be  seen  to  the  best  advantage 
by  a  comparative  study  of  plates  3  and  4.  The  original 
building  is  of  frame.  At  a  later  period  the  brick  additions 
were  built;  the  date  of  these,  however,  is  not  known,  nor 
is  it  known  whether  they  were  all  built  at  the  same  time. 
These  additions  include  a  small  one-story  brick  building 
to  the  right  of  the  original,  or  frame  building,  as  you  face 
the  front  of  the  house.  This  building  which  is  said  to 
have  been  used  by  McDowell  as  his  office  at  present 
serves  the  ignoble  purpose  of  a  negro  pool  room.  If  we  view 
the  frame  building  from  behind,  we  see  a  small  brick 
addition,  built  on  the  rear  corner  of  the  right  end  of  the 
building,  which  has  been  referred  to  in  the  old-fashioned 
term  as  a  "lean-to.'* 

71 


EPHRAiM  McDowell 

On  the  left  end  of  the  building,  rear  view,  is  a  rather 
long  brick  structure  of  several  rooms  with  a  sloping  roof 
that  admits  of  two  stories  where  it  joins  the  frame  building, 
and  but  one  at  its  farthest  extremity.  Between  these  two 
brick  structures,  seen  from  the  rear,  is  an  inclosed  porch, 
which  connects  the  two,  and  which  in  its  uninclosed  state 
probably  belonged  to  the  first  period  of  the  McDowell  home. 

Assuming  that  the  brick  structures  existed  during 
McDowell's  occupancy,  the  question  arises :  to  what  use 
were  they  originally  subjected?  The  farthest  room  of  the 
brick  structure  in  the  rear  on  the  left  end  was  most 
likely  the  kitchen.  Note  the  rear  broad  chimney  (Plate 
No.  4)  of  this  brick  addition  as  compared  with  the  small 
chimney  of  the  brick  "lean-to"  on  the  rear  right  end  of 
the  frame  building. 

It  was  the  custom  in  former  times  to  have  the  kitchen 
detached  from  the  dwelling,  and  frequently,  but  not 
always,  connected  with  the  home  through  a  covered 
passage.  Abundant  evidences  of  this  custom  may  still  be 
seen  throughout  the  South. 

The  explanation  of  this  arrangement  takes  us  back  to 
the  time  of  slavery.  Over  in  Virginia,  the  mother  state, 
distinct  lines  were  drawn  separating  the  cavalier  class 
from  the  "poor  whites";  but  when  it  came  to  the  slaves, 
such  a  distinction  was  not  even  made,  as  they  were  con- 
sidered in  an  entirely  different  light,  as  inferior  beings. 
Slaves  represented  a  valuable  asset  and  a  certain  affection 
existed  for  a  faithful  slave,  just  as  it  exists  for  a  thorough- 
bred horse,  but  beyond  that  they  were  kept  apart  from 
their  masters  and  others  of  the  white  race.  The  arrange- 
ment had  the  further  advantage  of  keeping  the  home  free 
from  culinary  odors,  and  afforded  a  better  protection  from 
fire,  a  danger  always  to  be  dreaded  in  isolated  rural 
districts. 

72 


MEMORABLE  CASE  OF  MRS.  JANE  TODD  CRAWFORD 

The  plan  of  the  McDowell  home  was  but  a  modifica- 
tion of  what  existed  in  the  more  spacious  homes  of  these 
regions.  If  this  room  was  the  kitchen,  what  purpose  did 
the  *' lean-to,"  located  at  the  right  rear  of  the  frame 
building,  serve,  assuming  that  it  existed  during  Mc- 
Dowell's time.f' 

This  "lean-to"  on  the  rear  right  corner  of  the  building 
when  viewed  from  behind,  or  to  the  left  of  the  building 
when  viewed  from  the  front,  has  on  different  occasions 
been  referred  to  as  the  probable  room  in  which  the  ovari- 
otomy was  performed.  If  it  can  be  shown  that  its  exist- 
ence corresponds  with  McDowell's  occupancy,  this  view 
becomes  a  very  reasonable  one. 

With  the  hope  of  reaching  a  more  accurate  solution 
of  this  and  other  mooted  questions,  a  correspondence  was 
entered  into  by  the  author  and  a  questionaire  sent  out  to 
such  persons  as  might  possess  any  information  on  the 
subject. 

Of  the  correspondence  which  resulted  therefrom  and 
which  is  germane  to  the  subject,  two  letters  deserve 
publicity. 

Smithsonian  Institution, 
Washington,  D.  C. 
Dr.  August  Schachner,  November  21,  1912. 

Louisville,  Ky. 
Dear  Sir: 

Referring  to  your  Inquiry  of  November  4,  I  beg  to  say  that, 
as  shown  on  the  photograph  in  this  museum  which  was  exhibited 
at  Jamestown,  the  operation  of  ovariotomy  was  performed  by 
Doctor  McDowell  in  the  annex  marked  one  on  your  photograph 
which  is  herewith  returned.  At  least  the  cross  appears  on  that 
part  of  the  photograph  which  is  in  our  possession.  I  should  state, 
however,  that  the  photograph  exhibited  at  Jamestown  was  only 
a  copy  of  one  in  the  Library  of  the  Surgeon-General's  Office, 
United  States  Army.  The  matter  has  been  called  to  the  atten- 
tion of  the  Librarian  in  the  last  few  days,  but  he  is  unfortunately 

73 


EPHRAiM  McDowell 

unable  to  find  any  clues  to  the  source  of  the  photograph  or  to 
furnish  conclusive  proof  that  room  No.  i  was  actually  the  place 
where  this  operation  was  performed. 

Very  respectfully  yours, 

(signed)         W.  de  C.  Ravenel  (?) 

Administrative  Assistant. 

The  annex  marked  No.  i  referred  to  in  the  above 
letter  is  the  "lean-to"  on  the  rear  right  corner  of  the 
building. 

One  of  several  letters  received  from  Dr.  Fayette  Dun- 
lap,  whose  parents  before  him  spent  their  lives  in  Danville, 
and  who  has  always  been  interested  in  the  history  of 
McDowell,  throws  some  light  upon  this  point. 

Dr.  Fayette  Dunlap, 

Danville,  Ky. 

My  Dear  Doctor:  i8th  Oct.,  1912. 

It  is  not  positively  known  whether  McDowell  died  at  Cam- 
bus  Kenneth  or  Travelers'  Rest.  The  presumption  is  in  favor 
of  the  former,  as  that  was  his  home  and  the  family  continued 
there  many  years  after  his  death.  Facing  the  home  of  Doctor 
McDowell,  the  little  brick  addition  to  the  left  is  supposed  to 
have  been  his  operating  room.  It  communicated  with  the  main 
building  by  a  large  covered-in  rear  porch.  The  one-story  brick 
room  (now  the  pool  room)  was  undoubtedly  his  office.  I  can 
remember  distinctly  that  the  operating  room  had  a  skylight  in 
it  that  was  changed  many  years  ago.  All  history  of  the  subse- 
quent life  of  Mrs.  Crawford  is  lost.  I  wish  I  could  help  you 
further,  and  will  do  so  when  I  can  find  anything  of  interest  and 
certainly  authentic.  I  may  accept  your  gracious  invitation  to 
visit  you,  and  if  you  should  come  to  Danville,  remember  that 
my  home  is  open  to  you  at  any  time. 
Sincerely  yours, 
(signed)     Fayette  Dunlap. 

This  Is  the  strongest  evidence  so  far  obtained  in  support 
of  the  view  that  the  "lean-to"  was  his  operating  room 
(provided  it  existed  at  the  time  the  first  ovariotomy  was 

74 


MEMORABLE  CASE  OF  MRS.  JANE  TODD  CRAWFORD 

performed)  and  that  it  may  easily  be  considered  the  room 
in  which  this  operation  took  place. 

The  negro  pool  room,  to  the  right  of  the  home,  front 
view,  has  also  been  spoken  of  in  this  connection.  This 
at  one  time  served  as  his  office,  but  it  is  hardly  probable 
that  he  would  perform  such  an  operation  in  his  office, 
even  if  the  room  could  be  shown  to  have  been  in  existance 
at  that  time.  This  would  have  been  an  inconvenient 
place,  to  begin  with,  and  after  the  operation  it  would  have 
been  necessary,  in  order  to  retain  the  use  of  the  office,  to 
remove  the  patient  to  another  house.  Needless  to  say 
such  an  arrangement  would  have  been  too  cumber- 
some on  the  one  hand,  and  on  the  other  since  the  opera- 
tion was  performed  on  December  13th,  it  would  have  been 
hazardous  because  of  the  exposure  to  cold. 

If  these  circumstances  are  properly  considered,  the 
claims  in  favor  of  the  "pool  room"  rapidly  fade,  for  such 
an  arrangement  would  represent  the  most  impractical  one 
he  could  have  selected.  McDowell  performed  this  opera- 
tion fourteen  years  after  he  began  his  career.  Certainly 
many  operations  upon  patients,  who  came  to  Danville 
for  that  purpose,  had  been  performed  prior  to  his  first 
ovariotomy.  Therefore  he  must  have  had  some  definite 
arrangement  to  care  for  these  cases,  and  his  office  would 
hardly  have  been  the  place. 

Dunlap  speaks  of  Danville  as  having  at  that  time  three 
hundred  inhabitants.  Had  the  population  been  three 
times  the  number,  it  is  scarcely  conceivable  that  Mc- 
Dowell would  have  had  some  place  other  than  his  home  for 
this  purpose.  Furthermore,  since  the  patients  after  all 
consisted  of  isolated  single  cases,  his  home  would  easily 
admit  of  such  an  arrangement. 

The  negro  "pool  room"  was  not  his  first  office.  We 
have  heard  it  referred  to  as  the  "office  he  had  later  on." 

75 


EPHRAiM  McDowell 

This  view  seems  the  correct  one,  and  his  former  office  no 
doubt  was  the  front  room  down  stairs  to  the  right  of  the 
entrance.  The  one  on  the  left  was  Mrs.  McDoweirs 
reception  room. 

An  examination  of  the  illustration  representing  the 
room  as  it  existed  in  the  summer  of  191 2,  bears  out  this 
view.  Built  into  the  wall  opposite  the  doorway  leading  into 
the  room,  are  two  closets.  Between  the  two  is  a  modern 
fireplace.  The  original  one,  it  was  said,  was  removed  by 
one  of  the  many  relic  hunters  that  for  years  have  preyed 
upon  this  historic  house. 

The  depth  of  these  closets  is  so  shallow  as  to  render 
them  unfit  for  ordinary  domestic  use,  and  from  the  dis- 
tances between  the  shelves,  it  is  plain  that  they  were  used 
possibly  for  books,  but  more  likely  for  bottles.  Here  he 
kept  either  his  library  or  his  drugs,  or  perhaps  both.  The 
closets  were  not  in  use  at  the  time,  and  when  opened  for 
the  photographer  they  were  streaked  throughout  with 
spider  webs,  a  circumstance  that  explains  the  mottled 
appearance  of  the  walls  of  the  closets  as  shown  in 
the  photograph. 

Although  this  room,  so  far  as  it  is  known,  has  not  been 
associated  with  the  operation,  its  claims  to  this  honor 
could  with  more  reason  be  urged  than  the  claims  of 
the  "pool  room." 

Should  it  be  established  that  the  "lean-to"  did  not 
exist  at  that  time,  this,  or  the  room  on  the  second  floor 
immediately  above  it,  would  seem  most  likely  to  be  the 
location.  If  operated  upon  in  the  "lean-to,"  the  patient 
could  have  been  allowed  to  remain  where  the  operation 
was  performed.  The  same  applies  to  the  front  rooms  on 
the  first  and  second  floors,  provided  he  was  using  as  his 
office  the  one-story  brick  building  which  is  now  the 
pool  room. 

76 


Upper  plate — Dr.  McDowell's  office.    Front  room  to  the  right  of  the  entrance,  as  it 

appeared  m  19 12. 

Front  hall  of  McDowell  house  as  it  appeared  in  19 12.    Door  to  the  right  leading  into  his 

office,  and  door  to  left  leading  into  Mrs.  McDowell's  drawing  room.    Note  character  of 

door  at  end  of  hallway. 


MEMORABLE  CASE  OF  MRS.  JANE  TODD  CRAWFORD 

If  this  pool  room  on  the  right  was  not  in  existence,  his 
office  was  in  his  home,  and  if  this  was  used  for  the  opera- 
tion, which  is  unUkely,  removal  of  the  patient  to  another 
part  of  the  house  would  almost  have  been  a  necessity. 
By  exclusion  we  would  then  think  of  the  corresponding 
room  on  the  second  floor  where  she  could  have  been 
allowed  to  remain,  or  that  she  might  have  been  removed 
to  the  room  just  behind  in  the  second  story  of  the  brick 
addition,  again  assuming  that  this  was  at  that  time 
in  existence. 

How  do  these  diflPerent  locations  harmonize  with  the 
statement  in  his  first  report,  "In  five  days  I  visited  her, 
etc.,"  and  what  interpretation  can  be  made  of  this  singular 
expression  that  exposed  him  to  the  sarcasm  of  his  earher 
critics  ?  Viewed  from  this  angle  the  claims  of  his  office, 
whether  it  was  the  "negro  pool  room"  or  the  front  room 
down  stairs,  fall  short.  If  his  office  was  at  that  time  in  the 
"negro  pool  room,"  which  in  a  way  made  the  front  room 
downstairs  available,  this  room  was  too  close  for  him  to 
have  avoided  it  even  if  he  so  desired.  It  would  have  been 
possible  for  him  to  have  performed  the  operation  in  the 
"lean-to,"  or  upstairs;  and  although  it  was  in  his  own 
house,  through  such  an  arrangement,  if  he  so  desired,  the 
case  was  capable  of  isolation. 

If  it  may  be  said  that  under  the  circumstances  Mc- 
Dowell was  obfigated  to  take  Mrs.  Crawford  under  his 
immediate  protection  when  he  performed  this  "experi- 
ment," how  can  we  think  of  his  intentionally  avoiding 
her  for  five  days  after  the  "experiment"  when  she  was 
in  his  own  home?  Such  a  thought  is  entirely  too  pre- 
posterous to  justify  a  moment's  consideration. 

If  we  expect  to  reach  a  satisfactory  solution  of  this 
question,  we  must  look  elsewhere  for  our  explanation.  On 
various  occasions  references  have  been  made  to  the  some- 

77 


EPHRAiM  McDowell 

what  loose  manner  in  which  his  first  report  was  prepared. 
Although  there  is  some  foundation  for  this  criticism,  this 
alone  would  not  lead  to  a  satisfactory  explanation  of 
his  phraseology.  Therefore  it  is  necessary  to  look  farther 
and  two  other  explanations  are  possible,  either  of  which  is 
reasonable  and  may  be  the  correct  one. 

In  the  card  which  he  issued  in  1826,  in  defense  of  his 
veracity  and  claims,  he  says,  ''Being  in  delicate  health  at 
the  time,  it  was  my  intention  to  remove  to  the  country 
in  the  spring,  or  as  soon  as  I  could  establish  my  nephew  in 
business."  From  this,  an  explanation  that  is  reasonable 
and  that  may  be  the  proper  one  is  possible.  McDowell's 
surgery,  we  are  told,  was  performed  under  an  intense  men- 
tal concentration;  and  even  if  we  reject  the  story  of  the 
mob,  it  is  still  inconceivable  that  he  was  not  exposed  to 
severe  criticisms,  particularly  since  he  was  not  free  from 
enemies.  That  the  gravity  of  the  step  may  have  weighed 
upon  him,  is  equally  plain.  If  these  conditions  existed, 
and  "if  he  was  in  delicate  health,"  it  would  not  be  unusual 
if  the  sum  total  to  which  he  had  just  been  exposed  had 
compelled  him  to  take  a  rest  in  the  country,  particularly 
as  he  was  planning  to  retire  to  the  country  later  on. 

Therefore,  the  possible  state  of  his  health  may  oflFer  a 
satisfactory  explanation;  or  it  is  not  unlikely  that  despite 
his  delicate  health,  he  may  have  received  an  urgent  call 
to  some  distant  patient,  which  kept  him  from  home  during 
the  specified  time.  These  views  receive  additional  sup- 
port from  the  statement  of  Dr.  J.  N.  McDowell,  and  from 
Mrs.  Crawford's  letter,  both  of  which  are  considered 
further  on. 

What  attracted  more  attention,  however,  and  what 
seemed  strangely  to  fascinate  others,  is  the  story  that  an 
angry  mob  surrounded  the  house,  and  threatened  his  life 
while  he  performed  the  operation.    As  the  story  goes,  the 

78 


MEMORABLE  CASE  OF  MRS.  JANE  TODD  CRAWFORD 

sheriff  intervened  and  effected  an  agreement  to  withhold 
action  until  the  result  was  known.  Woe  to  McDowell  if 
it  were  unfavorable! 

This  tradition,  which  clung  so  tenaciously  to  the  mem- 
ory of  McDowell,  and  which  with  time  grew  in  proportion 
and  intensity,  fades  out  in  direct  ratio  to  the  care  and 
accuracy  we  exercise  in  its  consideration,  until  there  is 
nothing  left  of  it  but  the  mouthings  of  a  certain  class  of 
busy-bodies,  who  always  find  more  interest  in  the  affairs 
of  their  fellow  creatures,  than  they  do  in  their  own  legiti- 
mate domain. 

To  say  that  this  step  so  repellent  in  the  light  of  the 
comparatively  primitive  state  of  surgery  as  it  existed  at 
that  time,  and  undertaken  in  a  small  country  town  of  a 
few  hundred  inhabitants,  was  not  the  chief  topic  of  the 
community,  would  be  a  distinct  misrepresentation  and  a 
direct  contradiction  of  one  of  the  strongest  traits  in  human 
nature,  curiosity. 

But  on  theother  hand,  to  lash,  so  to  speak,  this  curiosity 
into  such  proportions  that  we  see  the  house  surrounded 
by  a  determined  mob,  prepared  to  treat  him  as  they  would  a 
criminal  and  really  jeopardize  his  Hfe,  is,  we  beheve,  equally 
incorrect,  and  is  but  a  plain  example  of  the  least-disciplined 
trait  in  human  nature,  the  tendency  to  exaggerate. 

Although  McDowell  and  his  family  before  him  were 
among  the  very  first  citizens  of  those  times  and  places, 
this  fact  did  not  protect  him,  but  only  encouraged  the 
gossip  and  jealousy  of  certain  of  his  townspeople. 

Nor  did  it  stop  at  this.  His  prominence  and  respect- 
ability shielded  neither  him  nor  even  his  wife. 

Those  who  are  interested  in  this  phase  of  the  subject 
can  follov/  it  at  length  in  the  biograpi.y  of  McDowell  by 
his  granddaughter,  Mary  Young  Ridenbaugh,  or  in  the 
article  by  J.  P.  Chesney — "Interesting  Incidents  in  the 

79 


EPHRAiM  McDowell 

Private  Life  of  Ephraim  McDowell,"  Cincinnati  Medical 
Repertory,  1870.  As  for  ourselves,  we  purposely  forego 
any  detailed  reference  to  this  unsavory  petty  gossip. 

We  reiterate  that  it  is  impossible  to  appreciate  fully 
the  lives  of  McDowell  and  his  contemporaries,  or  to  under- 
stand completely  the  circumstances  and  difficulties  that 
attended  the  first  ovariotomy,  unless  we  are  able  to  visual- 
ize thoroughly  the  local  coloring  of  those  times.  There- 
fore, we  have  submitted  the  short  survey  of  this  period 
as  a  proper  introduction  to  the  understanding  of  the  lives 
of  these  pioneers  and  their  deeds.  In  this  connection 
it  must  not  be  overlooked  that  the  same  freedom  of 
action  which  favored  McDowell  in  the  performance  of  the 
operation  also  favored  the  criticism  of  the  operation 
among  his  townspeople. 

In  our  investigations  of  this  myth,  we  encountered 
from  different  sources  the  statement  that  the  excitement 
which  existed  at  that  time  originated  largely  through  the 
ill-judged  activity  of  a  minister  of  the  gospel.  Bearing 
upon  this  point  we  present  an  extract  from  some  remarks 
written  upon  the  back  of  the  questionnaire  in  further  ex- 
planation of  the  answers  which  Dr.  Fayette  Dunlap 
made  upon  the  opposite  side. 

My  Dear  Doctor: 

I  take  pleasure  in  giving  you  the  information  you  are  seek- 
ing. It  is  very  meagre,  but  what  is  given  is  fairly  accurate — 
as  accurate  as  tradition  usually  is. 

I  have  repeatedly  tried  to  find  from  what  source  the  tradi- 
tion of  the  mob  originated,  and  the  nearest  I  could  get  is,  that 
a  preacher  from  the  pulpit  called  attention  to  the  fact  that 
Doctor  McDowell  was  attempting  an  impossible  thing,  and  in 
the  event  of  the  woman's  death  he  would  be  a  murderer,  I 
rather  think  this  view  was  the  prevalent  one  among  the  people. 
There  were  then  less  than  three  hundred  people  in  Danville. 

80 


MEMORABLE  CASE  OF  MRS.  JANE  TODD  CRAWFORD 

An  uncle  of  mine,  who  was  nine  years  of  age  and  then  living 
in  Danville,  said  the  preacher  had  aroused  a  considerable  oppo- 
sition to  the  operation,  but  he  said  nothing  about  a  mob.  He 
furthermore  said  that  McDowell  was  a  silent,  phlegmatic  man, 
and  the  common  opinion  was  that  he  was  vastly  overrated;  a 
contemporary  and  competitor  said  of  him  that  "He  went  to 
Edinburgh  a  gosling  and  that  Edinburgh  made  a  goose  of  him." 

Our  little  town  was  greatly  disappointed  that  the  American 
Gynecological  Society  did  not  celebrate  the  McDowell  Centenary 
here.  The  town  extended  a  most  cordial  welcome  and  it  should 
have  been  accepted.    It  could  have  been  made  a  notable  event. 

Very  truly  yours, 
(signed)     Fayette  Dunlap- 

In  a  conversation  in  Danville,  during  the  summer  of 
191 2,  with  Colonel  Nick  McDowell,  who  was  then  well 
advanced  in  years,  we  heard  the  same  view  expressed. 
Colonel  McDowell  in  this  interview  made  a  significant  re- 
mark in  voicing  his  disapproval  of  the  idea  of  a  mob.  With 
a  spirited  look  of  defiance,  that  was  very  suggestive,  he 
said :  "  What  do  you  think  he  would  have  done  if  a  mob  had 
appeared  to  interfere  with  him?"  Exactly!  What  would 
you  naturally  expect  of  a  man  whose  great-grandfather 
fought  in  the  English  revolution,  whose  grandfather  fell 
defending  his  grant  of  land  against  the  Indians,  and  whose 
father  was  prominent  among  those  who  compelled  the 
acceptance  of  the  fact  that  there  were  some  people  on  the 
surface  of  the  globe  that  would  not  permit  even  the 
British  empire  to  run  over  them  ? 

Coming  to  the  man  himself,  as  a  student  we  find  him 
selected  by  his  fellow  students  at  Edinburgh  as  the  proper 
person  to  be  pitted  against  the  Irish  bully  who  could 
outrun  and  outdo  everyone  else,  and  it  is  a  pleasure  to 
note  that  their  confidence  was  not  misplaced. 

Now,  in  later  life,  when  he  is  confronted  with  a  problem, 
the  solution  of  which  is  clearly  dictated  by  his  conscience 
6  81 


EPHRAiM  McDowell 

and  his  common  sense,  and,  furthermore,  is  in  direct 
harmony  with  the  views,  the  adoption  of  which  was  being 
urged  after  the  discussions  of  a  century,  would  it  be  reason- 
able for  him  to  hesitate  and  falter  at  the  last  moment  in 
the  face  of  a  mob  ? 

If  there  had  been  nothing  else  to  Inspire  him  but  the 
willingness  and  the  heroism  of  this  woman,  who  entered 
^'nto  the  "experiment"  with  a  full  knowledge  of  the  step, 
and  whose  consciousness  was  intact  throughout  the  ordeal, 
this  to  such  a  man  would  have  been  quite  enough. 

If  there  had  been  any  blows  to  be  received,  or  shots 
to  be  fired,  there  would  also  have  been  blows  to  be 
given  and  shots  to  be  exchanged,  and  this,  it  is  reason- 
able to  conclude,  was  well  understood  in  Danville  upon 
that  occasion. 

Aside  from  the  unbridled  gossip  that  would  attend  any 
important  event  in  a  small  place  even  today,  and  that 
was  perhaps  even  more  In  evidence  at  that  time,  when 
more  freedom  prevailed  and  news  was  at  a  greater  pre- 
mium than  we  find  it  at  present,  the  story  of  the  mob 
disappears  Into  thin  air  upon  a  careful  reflection  on  the 
times  and  the  circumstances  attending  the  event. 

It  is  a  misfortune  that  no  notes  were  kept  which  would 
enable  us  to  understand  fully  all  the  details  of  the  step,  and 
more  especially  to  enter  into  his  point  of  view  and  his  esti- 
mate of  the  direct  and  indirect  importance  of  this  triumph. 

The  combination  of  circumstances  which  made  the 
step  possible  were  the  forecast  that  these  cases  should  and 
would  in  time  be  relieved  through  surgery.  The  entire 
willingness  on  the  part  of  Jane  Todd  Crawford  not  only 
to  go  the  limit  In  the  "experiment"  but  in  addition,  her 
courage  and  Insistence  that  the  opportunity  should  not 
be  lost,  a  fact  worthy  of  especial  note;  and,  lastly,  Mc- 
Dowell being  thrown  entirely  on  his  inherent  resources, 

82 


MEMORABLE  CASE  OF  MRS.  JANE  TODD  CRAWFORD 

and  isolated  in  a  time  and  a  place  that  were  noted  for 
daring  and  courageous  deeds. 

Had  he  lived  in  a  metropolitan  atmosphere,  under  the 
conservative  shadow  of  a  great  university,  it  is  not  unlikely 
that  the  discussion  of  the  case,  and  possibly  the  presenta- 
tion of  the  patient  with  great  solemnity  before  some 
august  body  of  medical  men,  would  have  been  the  order 
of  the  day.  This  would  most  likely  have  resulted  in  a 
long,  fruitless  discussion,  that  ended  in  discouragement 
and  disappointment. 

As  it  was,  he  fortunately  was  separated  from  all  deter- 
rent influences  of  any  note,  and  left  with  an  absolutely 
free  hand  to  follow  the  bent  of  his  conscience,  courage, 
and  common  sense. 

As  it  has  aptly  been  said  of  him,  "With  a  shrewd 
mother  wit,  and  a  firm  grasp  of  the  principles  of  the  healing 
art,"  he  approached  the  case  in  a  calm  and  clear-headed 
manner,  much  the  same  as  he  would  any  other  problem 
in  surgery.  While  his  more  pretentious  metropolitan  col- 
leagues would  have  wasted  their  energies  in  a  learned 
discussion  that  brought  them  nowhere,  he  quietly  but 
vigorously  expended  his  in  action  that  resulted  in  the 
accomplishment  of  the  deed.  That  this  statement  is  not 
overdrawn  is  amply  proved  by  the  action  of  John  Lizars 
fourteen  years  after  the  operation,  and  when  he  for  seven 
years  had  had  the  three-fold  successful  precedent  of 
McDowell  before  him  in  writing. 

It  would  be  interesting  to  know  McDowell's  estimate 
of  the  step.  Was  he  the  silent  phlegmatic  man  described 
by  some,  who  dealt  with  this  problem  in  the  same  matter- 
of-fact  way  that  he  would  deal  with  other  surgical  problems  ? 

Although  the  peritoneum  was  at  that  time  held  in 
great  awe,  and  the  prevailing  idea  was  that  any  inter- 
ference therewith  would  be  attended  with  grave  conse- 

83 


EPHRAiM  McDowell 

quences,  it  could  hardly  have  been  unknown  to  his  teacher, 
John  Bell,  that  history  afforded  several  isolated,  and  suc- 
cessful instances  in  which  it  was  opened,  and  such  opera- 
tions as  Caesarean  section,  ectopic  gestation,  volvulus  were 
performed  and  even  the  tapping  of  an  ovary  through  an  in- 
cision and  an  apparent  cure  through  drainage  was  effected. 

McDowell's  silence  for  seven  years  thereafter,  and 
the  publication,  only  after  the  repeated  solicitations,  on  the 
part  of  his  friends,  of  the  first  three  cases  in  such  a  simple, 
and  somewhat  indifferent  manner  would  lend  color  to  the 
view  that  he  hardly  grasped  the  full  importance  of  his 
achievement,  even  as  it  applied  to  ovarian  cases. 

It  was  not  to  be  expected  that  anyone,  at  that  time 
would  realize  that  the  report  of  these  three  cases,  really 
represented  the  birth  of  that  brilliant  and  marvelous 
division  of  the  healing  art  known  as  the  domain  of  ab- 
dominal surgery. 

This,  however,  is  the  full  significance  of  McDowell's 
work,  and  of  his  two  epoch-making  contributions  to  the 
surgical  literature  of  his  time,  simple  and  slipshod  as 
they  have  been  represented  to  be. 

After  the  publication  of  these  two  reports,  there  was 
no  longer  any  excuse  for  the  continuance  of  the  dread  in 
which  the  peritoneum  was  held.  This  fear,  which  so 
completely  paralyzed  all  action  and  incentive  in  the  ages 
that  preceded  these  epoch-making  cases,  had  now  spent 
its  force.  They  definitely  established  the  fact  that  the 
dangers  of  opening  the  peritoneum  were  more  apparent  than 
real,  and  with  this  fear  removed,  the  first  actual  step  was 
taken  in  the  development  of  the  surgery  of  the  abdomen. 

At  first  it  was  confined  to  the  ovaries,  but  gradually  it 
developed  until  every  organ  and  structure  within  the 
abdominal  and  pelvic  cavities  became  amenable  to  surgi- 
cal interference. 

84 


MEMORABLE  CASE  OF  MRS.  JANE  TODD  CRAWFORD 

He  built  far  better  than  anyone  at  that  time  could 
possibly  have  reahzed.  In  fact,  the  importance  of  the 
operation,  even  as  it  apphed  to  ovarian  tumors,  was  not 
appreciated  to  its  full  extent;  and  if  we  consider  the  time 
that  elapsed,  and  the  struggle  that  marked  its  extremely 
slow  and  gradual  adoption,  it  is  safe  to  add  that  its  full 
importance  was  not  even  remotely  suspected  by  anyone. 

Had  the  influence  of  this  operation  been  confined  to 
ovarian  surgery  alone,  it  would  have  been  of  sufficient 
importance  to  have  placed  the  womanhood  of  the  future 
under  lasting  obligation  for  this  priceless  contribution; 
but  when  we  consider  that  the  ovarian  operation  was  but 
the  prelude  to  the  most  brilliant  and  fruitful  division  of 
surgery,  involving  the  welfare  of  the  whole  of  the  human 
race,  we  wonder  how  humanity  in  general  and  the  medical 
profession  in  particular  could  so  long  and  so  completely 
remain  indifferent  to  the  honors  due  the  memory  of  this 
benefactor  of  both.  And  when  we  witness  the  building 
of  monuments  and  memorials  to  lesser  idols  of  more 
ordinary  clay,  we  are  reminded  of  Sir  Herbert  Spencer's 
observation,  "Men  act  not  when  their  minds  are  con- 
vinced, but  when  their  sentiments  are  stirred."  Such 
action  is  not  intellectual,  it  is  emotional. 

If  this  represents  the  scope  of  McDowell's  labors,  is 
it  fair  to  stop  with  the  title  of  Father  of  Ovariotomy }  Is 
he  not  entitled  to  the  more  comprehensive  honor  of  Founder 
of  Abdominal  Surgery?  Certainly  his  work  is  the  very 
cornerstone  of  abdominal  surgery;  and  why  should  he  not  at 
this  late  day  be  accorded  the  full  measure  of  his  glory  ?  To 
refer  to  him  as  the  Father  of  Ovariotomy  and  the  Founder 
of  Abdominal  Surgery  is  nothing  more  than  common 
justice,  that  has  been  so  long  delayed,  and  that  now  should 
no  longer  be  denied.  ^ 

85 


CHAPTER  V 

Mcdowell's  report  of  his  first  three  cases — dr.  james 
Johnson's  criticisms  of  mcdowell — the  contribution 

of  JOHN   LIZARS "OBSERVATIONS   ON  EXTIRPATION  OF  THE 

OVARIA,    WITH    cases" FATE    OF    McDOWELl's    REPORT    IN 

THE  HANDS   OF  PHILIP   SYNG   PHYSICK  AND  THOMAS   CHALK- 
LEY    JAMES. 

Since  McDowell's  contributions  to  surgery  consist  of 
but  two  short  articles,  published  with  an  interim  of  two 
years,  and  as  each  is  important  in  its  way,  and  both  are 
short,  we  deem  it  proper  to  reproduce  them  in  full. 

Three  Cases  of  Extirpation  of  Diseased  Ovaria,^  by  Ephraim 
McDowell,  M.D.,  of  Danville,  Kentucky. 

In  December,  1809,  I  was  called  to  see  a  Mrs.  Crawford, 
who  had  for  several  months  thought  herself  pregnant.  She 
was  affected  with  pains  similar  to  labor  pains,  from  which  she 
could  find  no  relief.  So  strong  was  the  presumption  of  her 
being  in  the  last  stage  of  pregnancy  that  two  physicians,  who 
were  consulted  on  her  case,  requested  my  aid  in  delivering  her. 
The  abdomen  was  considerably  enlarged  and  had  the  appear- 
ance of  pregnancy,  though  the  inclination  of  the  tumor  was  to 
one  side,  admitting  of  an  easy  removal  to  the  other.  Upon 
ezamination,  per  vaginam,  I  found  nothing  in  the  uterus,  which 
induced  the  conclusion  that  it  must  be  an  enlarged  ovarium. 
Having  never  seen  so  large  a  substance  extracted  nor  heard 
of  an  attempt  or  success  attending  any  operation  such  as  this 
required,  I  gave  to  the  unhappy  woman  information  of  her 
dangerous  situation.  She  appeared  willing  to  undergo  an  experi- 
ment, which  I  promised  to  perform  if  she  would  come  to  Dan- 
ville (the  town  where  I  live),  a  distance  of  sixty  miles  from  her 
place  of  residence.  This  appeared  almost  impracticable  by 
any,  even  the  most  favorable  conveyance,  though  she  performed 
the  journey  in  a  few  days  on  horseback.  With  the  assistance 
of  my  nephew  and  colleague,  James  McDowell,  M.D.,  I  com- 

1  The  Eclectic  Repertory,  1817,  vol.  vii,  p.  242. 

86 


McDowell's  report  of  his  first  three  cases 

menced  the  operation,  which  was  concluded  as  follows:  Having 
placed  her  on  a  table  of  the  ordinary  height,  on  her  back,  and 
removed  all  her  dressing  which  might  in  any  way  impede  the 
operation,  I  made  an  incision  about  three  inches  from  the 
musculus  rectus  abdominis,  on  the  left  side,  continuing  the 
same  nine  inches  in  length,  parallel  with  the  fibres  of  the  above- 
named  muscle,  extending  into  the  cavity  of  the  abdomen,  the 
parietes  of  which  were  a  good  deal  contused,  which  we  ascribed 
to  the  resting  of  the  tumor  on  the  horn  of  the  saddle  during  her 
journey.  The  tumor  then  appeared  full  in  view,  but  was  so 
large  that  we  could  not  take  it  away  entire.  We  put  a  strong 
ligature  around  the  Fallopian  tube  near  the  uterus,  and  then 
cut  open  the  tumor,  which  was  the  ovarium  and  fimbrious  part 
of  the  Fallopian  tube  very  much  enlarged.  We  took  out  fifteen 
pounds  of  a  dirty,  gelatinous-looking  substance,  after  which  we 
cut  through  the  Fallopian  tube  and  extracted  the  sack,  which 
weighed  seven  pounds  and  one-half.  As  soon  as  the  external 
opening  was  made  the  intestines  rushed  out  upon  the  table,  and 
so  completely  was  the  abdomen  filled  by  the  tumor  that  they 
could  not  be  replaced  during  the  operation,  which  was  termin- 
ated in  about  twenty-five  minutes.  We  then  turned  her  upon 
her  left  side,  so  as  to  permit  the  blood  to  escape,  after  which  we 
closed  the  external  opening  with  the  interrupted  suture,  leaving 
out,  at  the  lower  end  of  the  incision,  the  ligature  which  sur- 
rounded the  Fallopian  tube.  Between  every  two  stitches  we 
put  a  strip  of  adhesive  plaster,  which,  by  keeping  the  parts  in 
contact,  hastened  the  healing  of  the  incision.  We  then  applied 
the  usual  dressings,  put  her  to  bed,  and  prescribed  a  strict 
observance  of  the  antiphlogistic  regimen.  In  five  days  I  visited 
her,  and  much  to  my  astonishment  found  her  engaged  in  making 
up  her  bed.  I  gave  her  particular  caution  for  the  future,  and 
in  twenty-five  days  she  returned  home  as  she  came,  in  good 
health,  which  she  continues  to  enjoy. 

Since  the  above  case  I  was  called  to  a  negro  woman,  who 
had  a  hard  and  very  painful  tumor  in  the  abdomen  (1813). 
I  gave  her  mercury  for  three  or  four  months  with  some  abate- 
ment of  pain,  but  she  was  still  unable  to  perform  her  usual 
duties.  As  the  tumor  was  fixed  and  immovable,  I  did  not  advise 
an  operation;  though,  from  the  earnest  solicitation  of  her  master, 
and  her  own  distressful  condition,  I  agreed  to  the  experiment. 

87 


EPHRAiM  McDowell 

I  had  her  placed  upon  a  table,  laid  her  side  open,  as  in  the  above 
case,  put  my  hand  in,  found  the  ovarian  very  much  enlarged, 
painful  to  the  touch,  and  firmly  adhering  to  the  vesica  urinaria 
and  the  fundus  uteri.  To  extract  I  thought  would  be  instantly 
fatal;  but  by  way  of  experiment,  I  plunged  the  scalpel  into  the 
diseased  part,  such  gelatinous  substance  as  in  the  above  case, 
with  a  profusion  of  blood,  rushed  to  the  external  opening,  and 
I  conveyed  it  off  by  placing  my  hand  under  the  tumor  and  suffer- 
ing the  discharge  to  take  place  over  it.  Notwithstanding  my 
great  care,  a  quart  or  more  of  blood  escaped  into  the  abdomen. 
After  the  hemorrhage  ceased,  I  took  out  as  cleanly  as  possible 
the  blood,  in  which  the  bowels  were  completely  enveloped. 
Though  I  considered  the  case  as  nearly  hopeless,  I  advised  the 
same  dressings  and  the  same  regimen  as  in  the  above  case. 
She  has  entirely  recovered  from  all  pain  and  pursued  her  ordin- 
ary occupation. 

In  May,  i8i6,  a  negro  woman  was  brought  to  me  from  a 
distance.  I  found  the  ovarian  much  enlarged,  and  as  it  could 
be  easily  moved  from  side  to  side,  I  advised  the  extraction  of  it. 
As  it  adhered  to  the  left  side  I  changed  my  plan  of  opening  to 
the  linea  alba.  I  began  the  incision,  in  company  with  my  partner 
and  colleague,  Dr.  William  Coffer,  an  inch  below  the  umbilicus, 
and  extended  it  to  within  an  inch  of  the  os  pubis.  I  then  put  a 
ligature  around  the  Fallopian  tube  and  endeavored  to  turn  out 
the  tumor  but  could  not.  I  then  cut  to  the  right  of  the  umbilicus 
and  above  it  two  inches,  turned  out  a  scirrhous  ovarian  (weighing 
six  pounds),  and  cut  it  off  close  to  the  ligature  put  around  the 
Fallopian  tube.  I  then  closed  the  external  opening,  as  in  the 
former  cases,  and  she  complaining  of  cold  and  chilliness,  I  put 
her  to  bed  prior  to  dressing  her;  then  gave  her  a  wineglassful  of 
cherry  bounce  and  thirty  drops  of  laudanum,  which  soon  restor- 
ing her  warmth,  she  was  dressed  as  usual.  She  was  well  in  two 
weeks,  though  the  ligature  could  not  be  released  for  five  weeks, 
at  the  end  of  which  time  the  cord  was  taken  away,  and  she  now, 
without  complaint,  officiates  in  the  laborious  occupation  of  cook 
to  a  large  family. 

The  foregoing  contribution,  which  is  the  first  of  his 
two  articles,  has  been  variously  referred  to  as  direct, 
simple,  loose,  and  slipshod.    We  have  already  spoken  of 

88 


McDowell's  report  of  his  first  three  cases 

how  it  exposed  him  to  the  ridicule  and  sarcasm  of  Dr. 
James  Johnson,  of  the  Lon.  Med.  Chir.  Rev. 

In  view  of  what  at  that  time  was  not  unjustly  consid- 
ered an  unbeHevable  accomplishment,  related  in  a  simple 
and  somewhat  loose  manner  and  coming  from  the  wilds 
of  a  new  country,  it  is  not  altogether  surprising  that  it 
should  have  been  looked  upon  in  the  light  of  a  "  fairy  tale." 
At  least  there  are  extenuating  circumstances  which  should 
be    considered    in    our   judgment  of   McDowell's  critics. 

Simple  and  slipshod  as  these  contributions  were  con- 
sidered at  that  time,  there  is,  however,  another  side  to  the 
shield.    This  is  not  the  only  criticism  that  can  be  made. 

McDowell,  notwithstanding  his  abihty  and  accom- 
plishments, which  were  unmistakable,  was  after  all  a 
country  doctor  practicing  in  the  wilderness  in  a  time 
when  medical  journals  were  few.  It  was  not  the  custom 
then  to  strain  every  effort  to  rush  into  print  as  is  the  not 
uncommon  practice  today.  Under  the  present  order  of 
affairs  clinics  have  been  built  up,  not  so  much  through 
extraordinary  ability,  as  through  extraordinary  publicity. 
Such  a  condition  has  been  made  possible  very  largely 
through  a  more  perfect  system  of  communication,  and  a 
better  means  of  travel  than  existed  at  that  time.  The 
life  of  a  country  doctor  then  was  even  more  laborious 
than  now,  with  the  easier  means  of  moving  from  place 
to  place.  Such  a  life  left  but  little  time  for  rest,  not 
to  mention  contributions  to  medical  literature. 

With  all  due  respect  to  McDowell,  there  is  no  reason 
why  we  should  consider  him  a  learned  or  cultured  man 
who  would  naturally  incline  to  writing.  He  was  not 
what  we  would  call  a  student;  he  was  essentially  a  man 
of  action.  Naturally  modest  and  retiring,  and  anything 
but  a  litterateur^  it  is  not  surprising  that  he  should  record 

.89 


EPHRAiM  McDowell 

his  abdominal  operations,  then  not  fully  appreciated  by- 
anyone,  in  a  simple,  straightforward  manner. 

The  publication  of  these  three  cases  met  with  jeers 
and  derision.  The  epithet  of  liar  was  certainly  indirectly, 
and  possibly  directly,  hurled  at  him  in  his  own  country, 
as  well  as  abroad.  If  this  was  the  reception  accorded  his 
first  three  consecutive  and  successful  cases,  what  would 
have  been  the  effect  if  he  had  published  his  first  case 
without  waiting  for  the  corroboration  which  the  two  addi- 
tional cases  afforded?  Its  reception  would  have  been  no 
less  offensive,  and  the  influence  of  such  criticisms  upon 
McDowell  might  have  deterred  him  from  further  action. 
The  case  would  then  have  remained  a  solitary  and  un- 
confirmed one,  and  thus  have  lost  its  effect,  like  other 
solitary  efforts,  that  history  affords  and  that  have  lost  the 
lasting  character  of  their  influence,  mainly  because  of  their 
lack  of  corroboration.  It  might  then  have  dwindled  into 
the  innocuous  role  of  a  surgical  curiosity  instead  of  becom- 
ing, as  it  did,  a  powerful  factor  which  could  not  be 
overlooked  or  ignored,  and  which  directly  led  to  such 
far  reaching  results. 

As  it  was,  he  modestly  attributed  an  undue  amount 
of  credit  to  his  good  fortune,  rather  than  to  his  good 
judgment.  But  confronted  with  three  consecutive  cases, 
it  was  no  longer  an  accident  in  any  sense,  but  an  estab- 
lished fact,  the  bowlings  of  Doctor  Johnson,  or  anyone 
else,  could  not  now  shake  the  foundation  of  this  fact,  nor 
in  the  future  deter  him  from  continuing  in  his  course. 
'  Furthermore  after  his  second  contribution,  published 
two  years  later,  which  added  two  other  cases  to  his  list, 
even  Doctor  Johnson  began  to  weaken.  Johnson's  atten- 
tion was  first  called  to  the  matter  through  the  article 
published  by  Mr.  Lizars. 

90 


MCDOWELL'S  REPORT  OF  HIS  FIRST  THREE  CASES 

In  Doctor  Johnson's  review  of  Mr.  Lizar's  paper 
occur  the  significant  remarks: 

Passing  over  the  records  of  surgery,  all  of  which  cannot  be 
depended  on,  we  shall  come  at  once  to  the  recent  facts,  or 
alleged  facts,  communicated  in  this  paper  by  Mr.  Lizars.  Three 
cases  of  ovarian  extirpation  occurred,  it  would  seem,  some  years 
ago  in  the  practice  of  Doctor  MacDowell,  of  Kentucky,  which 
were  transmitted  to  the  late  John  Bell,  and  fell  into  the  hands 
of  Mr.  Lizars.  We  candidly  confess  that  we  are  rather  skeptical 
respecting  these  statements,  and  we  are  rather  surprised  that 
Mr.  Lizars  himself  should  put  implicit  confidence  in  them. 

Then  followed  a  brief  review  of  McDowell's  cases  and 
the  already  well-known  sarcastic  passage:  "Doctor  Mac 
visited  his  patient  in  five  days,"  etc.,  closing  with  the 
rebuff,  "We  cannot  bring  ourselves  to  credit  this  state- 
ment." This  occurred  soon  after  the  publication  of 
Mr.  Lizars'  paper  in  the  Edinburgh  Medical  Journal, 
October,  1824. 

In  January,  1825,  Doctor  Johnson,  in  reviewing 
Doctor  Blundell's  work,  "Researches,  Physiological  and 
Pathological:  instituted  principally  with  a  View  to  the 
Improvement  of  Medical  and  Surgical  Practice,  by  Pro- 
fessor James  Blundell,"  in  which  the  author  spoke  favor- 
ably of  the  future  of  ovariotomy,  renews  his  attack 
by  saying: 

In  despite  of  all  that  has  been  written  respecting  this  cruel 
operation,  we  entirely  disbelieve  that  it  has  ever  been  performed 
with  success,  nor  do  we  think  it  ever  will. 

In  October,  1826,  after  receiving  the  North  American 
Medical  and  Surgical  Journal,  1826,  Doctor  Johnson 
shows  signs  of  relenting  in  the  following  acknowledgment : 

Extirpation  of  an  Ovarium. — ^A  back  settlement  of  America 
— ^Kentucky — has  beaten  the  mother  country,  nay,Europe  itself, 
with  all  the  boasted  surgeons  thereof,  in  the  fearful  and  formid- 
able operation  of  gastrotomy,  with  extraction  of  diseased  ovaria. 

91 


EPHRAiM  McDowell 

In  the  second  volume  of  this  series,  page  216,  we  adverted  to 
the  cases  of  Doctor  MacDowell,  of  Kentucky,  published  by 
Mr.  Lizars,  of  Edinburgh,  and  expressed  ourselves  as  skeptical 
respecting  their  authenticity.  Doctor  Coates,  however,  has  now 
given  us  much  more  cause  for  wonder  at  the  success  of  Doctor 
MacDowell;  for  it  appears  that  out  of  five  cases  operated  on  in 
Kentucky  by  Doctor  M,  four  recovered  after  the  extraction,  and 
only  one  died.  There  were  circumstances  in  the  narrative  of 
some  of  the  first  three  cases  that  raised  misgivings  in  our  minds, 
for  which  uncharitableness  we  ask  pardon  of  God  and  of 
Doctor  MacDowell,  of  Danville.  Two  additional  cases  now 
published  (for  it  appears  that  the  cases  were  published,  though 
in  a  very  unsatisfactory  form,  in  the  American  Eclectic  Reper- 
tory) are  equally  wonderful  as  those  with  which  our  readers 
are  already  acquainted. 

Instead  of  realizing  at  this  point  that  he  had  at  last 
said  enough,  he  shows  us  how  hard  the  stubborn  die  by 
disclosing  the  string  attached  to  his  apology  which,  meta- 
phorically speaking,  was  blasted  out  of  him  when  he  says: 
"It  was  the  mode  of  narration  that  excited  our  skepticism, 
and  we  must  confess  it  is  not  yet  removed." 

We  may  fairly  explain  McDowell's  attitude  towards 
his  ovariotomies,  and  his  delay  and  seeming  indifference 
to  the  publication  of  his  cases,  on  the  basis  of  modesty, 
preoccupation,  the  increasing  demands  and  hardships  of  a 
growing  practice  in  a  new  country  with  few  conveniences, 
and,  lastly,  the  lack  of  the  full  appreciation  of  the  achieve- 
ment, even  as  it  applied  to  the  ovarian  cases. 

Through  the  repeated  urgings  of  his  friends,  and  his 
nephew,  William  McDowell,  he  was  prevailed  upon  to 
prepare  the  report  of  his  first  three  cases.  This  was  after 
a  lapse  of  seven  years.  In  18 16  one  copy  was  forwarded 
to  his  old  teacher,  John  Bell,  but  it  fell  into  the  hands  of 
John  Lizars,  who  had  charge  of  Bell's  patients  and  corre- 
spondence, during  his  absence;  another  was  sent  to  Philip 
Syng  Physick  of  Philadelphia. 

92 


McDowell's  report  of  his  first  three  cases 

It  was  the  publication  of  the  copy  sent  to  Bell,  and 
offered  by  Lizars  as  part  of  a  paper  of  his  own,  together 
with  the  savage  criticisms  thereon  by  Dr.  James  Johnson, 
that  awakened  Europe  and  that  in  turn  aroused  America 
more  than  any  other  effort. 

This  paper  by  John  Lizars,  of  which  so  much  can  be 
said  in  comparison  with  McDowell's  publication,  is  so 
interesting  from  various  viewpoints,  and  played  such  an 
important  part  in  focussing  attention  upon  ovariotomy, 
that,  with  the  exception  of  McDowell's  report,  which  it 
includes,  but  which  we  through  lack  of  space  have  elimin- 
ated, it  is  here  reproduced  in  full. 

Barring  the  omission  of  McDowell's  first  communica- 
tion, which  was  included  in  Lizar's  paper,  it  seems  justi- 
fiable to  reprint  the  long  paper  of  Lizars  in  order  that  we 
may  compare  the  simple  direct  statement  of  McDowell 
with  that  of  Lizars,  which  followed  the  standard  expected 
at  that  period. 

Observations  on  Extirpation  of  the  Ovaria,  with  Cases.  By- 
John  Lizars,  F.R.S.E.,  F.R.C.S.E.,  and  Lecturer  on  Anat- 
omy and  Physiology,  Edinburgh. 

Cat  exemple,  et  celui  de  ramputation  totale  de  I'uterus  et 
du  vagin,  pratiquee  avec  succes,  autorisent  egalement  a  assurer 
avec  las  connoissances  profondes  de  I'anatomia,  il  n'ast  guere 
d'organas  sur  lesquels  on  ne  puisse  exercar  avec  avantaga  las 
diversas  oparations  de  la  chirurgia. — UAumonier. 

From  tha  records  of  madicine,  the  ovaria  seem  as  subject 
to  disease  as  any  other  organ  in  tha  body;  and,  from  their 
attaining  enormous  size,  producing  great  pain,  and  destroying 
tha  life  of  the  sufferer,  they  have  early  called  tha  attention  of 
practitioners.  They  appear  subject  to  dropsy,  tha  fluid  being 
contained  either  in  one  or  more  cysts;  and  to  dropsy,  combined 
with  various  degenerations  of  texture  and  morbid  productions. 
Various  modes  of  treatment  have  been  invented,  and  had 
recourse  to,  for  the  numerous  varieties  of  this  disease.    For  the 

93 


EPHRAiM  McDowell 

simple  dropsical  affection,  tapping,  or  paracentesis  abdominis, 
has  been  employed;  but  it  has  only  proved  a  temporary  pallia- 
tive. Puncturing,  and  keeping  the  orifice  open,  so  as  to  seize 
hold  of  the  sac  and  remove  it  gradually,  has  effected  a  permanent 
cure;  and  the  same  end,  it  will  appear,  has  been  accomplished 
by  the  operation  of  gastrotomy,  or  the  making  a  free  incision 
into  the  abdomen,  and  removing  the  entire  sac,  especially  where 
the  tumor  has  consisted  of  some  firm  substance. 

Le  Dran  cured  dropsy,  with  scirrhus  of  the  ovarium,  by 
incision  and  suppuration;  and  Professor  Dzondi  of  Halle'  in- 
formed me  that  he  had  frequently  cured  this  disease  by  incision, 
and  the  introduction  of  a  tent,  and  afterwards  removing  the 
sloughing  sac  by  the  forceps. 

But  the  total  extirpation  of  the  ovarium,  both  in  a  healthy 
and  diseased  state,  has  been  performed;  and  it  is  the  design  of 
this  paper  to  consider  the  propriety  of  such  an  operation,  with 
the  view  of  obtaining  a  radical  cure  of  dropsical  ovarium.  "On 
chatre,"says  Morand,  "les  femelles  non  seulement  des  volatiles, 
mais  meme  des  quadrupeds,  sans  danger.  Cette  operation 
appliquee  aux  femmes  n'a  point  paru  une  chimere  a'  Felix 
Platerus  et  a'  Diemerbroeck;  c'etoit  au  rapport  de  Heyschius 
une  operation  commune  chez  les  Lydiens,  pour  des  raisons  qui 
ne  sont  point  de  I'art."  In  other  examples,  also,  the  peritoneal 
cavity  has  been  freely  laid  open,  both  accidentally  and  inten- 
tionally, and  the  intestines  exposed  to  the  contact  of  the  air, 
without  injur}^  Paulus  Barbette,  of  Amsterdam,  laid  open  the 
abdomen,  and  disengaged  the  strangulated  or  twisted  intestine 
in  a  case  of  volvulus.  Bonetus  relates  the  case  of  a  lady  who  was 
dying  of  intussusception,  when  a  military  surgeon  opened  the 
abdomen,  disentangled  the  twisted  intestine,  and  effected  a 
cure.  Schacht  operated  for  the  same  peculiar  disease  with  suc- 
cess. Besides  these,  there  are  many  well-authenticated  cases 
of  the  Csesarian  operation  performed,  even  for  six  times  on  the 
same  woman,  with  success.  In  mostly  all  the  cases  of  diseased 
ovaria  on  record,  and  in  all  the  dissections  of  this  disease  which 
I  have  witnessed,  the  tumor  was  appended  by  a  small  pedicle, 
merely  the  broad  ligament  of  the  uterus.  The  largest  I  ever 
saw,  I  have  kept  as  a  preparation;  and  although  a  great  quantity 
of  the  gelatinous  matter,  and  all  the  serous  fluid,  has  been 
necessarily  removed,  it  still  weighs  twenty-five  pounds. 

94 


THE  CONTRIBUTION  OF  JOHN  LIZARS 

But  the  practicability  of  extirpating  a  diseased  ovarium 
does  not  rest  on  theory.  It  has  been  proved  by  experience. 
L'Aumonier,  who  was  chief  surgeon  of  the  great  hospital  at 
Rouen  about  fifty  years  ago,  extirpated  the  ovarium  successfully; 
and  since  his  time  an  ovarium  has  been  repeatedly  removed,  and 
sometimes  with  success,  particularly  in  France,  Germany,  and 
America.  Doctor  Smith,  of  Connecticut,  lately  extirpated  an 
ovarium  in  a  dropsical  state,  successfully.  Three  very  instruc- 
tive cases  occurred  to  Doctor  MacDowell,  of  Kentucky;  and  the 
following  history  of  them  was  sent,  about  seven  years  ago,  to 
the  late  celebrated  surgeon  Mr.  John  Bell,  who  was  then  on 
the  Continent,  and  came  into  my  hands  as  having  the 
charge  of  his  patients  and  professional  correspondence  during 
his  absence. 

(Here  Lizars  included  a  verbatim  report  of  McDowell's 
first  paper.) 

In  theyear  1821,1  was  requested  by  my  friend.  Doctor  Camp- 
bell, lecturer  on  midwifery,  to  visit  a  woman  with  an  abdomen 
as  large  as  if  in  the  ninth  month  of  gestation.  On  examination, 
the  tumor  occupied  the  whole  abdominal  cavity,  and  appeared 
to  roll  from  side  to  side;  the  uterus  per  vaginam  felt  natural, 
and  her  catamenia  had  been  regular,  but  caused  excruciating 
pain  when  they  occurred.  She  stated  that  she  was  twenty-seven 
years  of  age,  had  borne  only  one  child,  and  in  twelve  months 
afterwards  had  a  miscarriage,  two  or  three  months  after  which, 
towards  the  end  of  18 15,  she  became  sensible  of  a  considerable 
enlargement  of  her  belly,  that  began  on  the  left  side,  and  which 
she  attributed  to  several  blows  and  kicks  received  from  a  brutal 
husband,  from  whom  she  was  now  separated;  that  her  neighbors 
now  abused  her,  and  made  such  complaints  to  her  employers 
that  they  dismissed  her.  At  that  time  she  earned,  and  now 
earns,  her  livelihood  by  binding  shoes.  Being  now  without  the 
means  of  support,  she  applied  to  a  county  hospital,  but  was  in  a 
few  days  dismissed,  on  the  supposition  of  being  with  child.  She 
then  consulted  a  number  of  respectable  practitioners,  but  all 
of  them  cruelly  taunted  her  with  being  pregnant.  At  the  end 
of  two  years  she  perceived  a  small  moveable  swelling  in  her  left 
groin,  which  she  allowed  to  increase  for  twelve  months,  when  she 
came  to  Edinburgh,  and,  on  consulting  a  surgeon,  he  opened  it 
with  a  lancet,  and  discharged  a  large  quantity  of  thin  matter. 

95 


EPHRAiM  McDowell 

On  examination  this  was  a  lumbar  abscess,  which  she  ascribed 
to  a  fall  on  her  back  three  years  previously.  The  evacuation  of 
this  fluid  did  not  in  the  least  diminish  the  magnitude  of  the 
abdomen;  and  she  imagined  she  could  distinguish  between  the 
pain  of  the  lumbar  abscess  and  that  of  the  tumor  in  the  abdomen. 
She  was  admitted  into  the  hospital  of  this  place,  and  remained 
for  thirteen  weeks,  without  receiving  any  relief.  She  consulted 
the  chief  medical  gentlemen  of  this  city,  many  of  whom  pro- 
nounced her  pregnant,  and  all  of  them  tried  to  dissuade  her 
from  an  operation.  Two  put  her  under  different  courses  of 
mercury,  and,  after  a  consultation,  one  punctured  the  abdomen 
for  dropsy  of  the  ovarium. 

Before  having  recourse  to  the  operation  of  gastrotomy,  I 
deemed  it  my  duty  to  have  the  opinion  of  the  principal  prac- 
titioners of  this  city,  either  by  personal  consultation,  or  by 
sending  the  patient  to  them.  The  woman  herself  also  had 
previously  waited  on  many  of  them.  Some  said  that  to  operate 
would  be  rash;  others,  that  I  would  kill  my  patient.  It  was 
agreed  by  all,  that  there  was  a  disease  of  one  or  both  ovaries; 
and  she  had  been  twice  tapped  for  dropsy  of  the  left  ovary,  the 
result  of  a  formal  consultation  of  some  of  the  ablest  medical 
men  of  this  city.  Convinced,  from  the  history  of  the  disease 
in  the  records  of  medicine,  and  from  gastrotomy  having  been 
successfully  performed  for  volvulus,  and  from  the  Caesarian 
section,  that  there  was  little  to  apprehend  either  from  loss  of 
blood  or  peritoneal  inflammation,  I  felt  desirous  to  endeavor 
to  relieve  the  woman  by  an  operation;  but  was  anxious  to  have 
the  sanction  of  some  other  surgeon  or  physician  besides  my  friend 
Doctor  Campbell,  who  at  once  offered  to  assist  me.  All  whom  I 
took  to  see  the  patient,  and  all  to  whom  I  sent  her,  said  that 
the  disease  was  an  affection  of  the  ovarium,  but  all  of  them  con- 
demned an  operation.  My  patient,  therefore,  abandoned  to 
her  gloomy  condition,  called  on  me  repeatedly,  urging  me  to 
try  the  operation,  otherwise  she  would  do  it  herself.  At  last, 
as  her  pain  became  perfectly  intolerable,  and  she  was  still  urgent, 
I  resolved  to  operate.  During  the  preceding  period  I  had 
directed  my  attention  to  the  lumbar  abscess,  and  applied  caustic 
eschar  after  eschar. 

Wednesday,  24th  October,  1823,  was  the  day  appointed  for 
the  operation;  therefore,  on  the  day  preceding,  she  took  a  dose 

96 


THE  CONTRIBUTION  OF  JOHN  LIZARS 

of  the  compound  powder  of  jalap,  which  operated  also  on  Wed- 
nesday morning,  so  as  to  preclude  the  necessity  of  administering 
an  enema;  she  also  made  water  immediately  before,  in  order  to 
empty  the  bladder.  The  emptying  of  the  rectum  by  a  glyster, 
and  the  drawing  off  the  urine,  or  taking  care  that  the  patient 
makes  water,  are  circumstances  of  some  consequence  to  be 
attended  to  in  all  operations  of  the  abdominal  cavity.  As 
inflammation  appears  to  be  induced  generally  by  exposure  to 
cold;  and  as  these  cases  succeeded  so  well  in  America,  I  desired 
the  room  to  be  heated  to  80  degrees  Fahrenheit.  When  the 
temperature  of  the  room  had  arrived  at  this  heat,  I  placed  the 
patient  on  a  table,  covered  with  a  mattress,  and  two  pillows  sup- 
porting her  head,  and  commenced  the  operation,  in  the  presence  of 
Doctor  Campbell,  Doctor  Vallange,  late  surgeon  of  the  33d  regi- 
ment, Mr.  Bourchier,  surgeon  of  the  36th  regiment,  and  several 
other  medical  gentlemen,  by  making  a  longitudinal  incision, 
parallel  with,  and  on  the  left  side  of  the  linea  alba,  about  two 
inches  from  the  ensiform  cartilage,  to  the  crusta  of  the  os  pubis, 
through  the  skin  and  cellular  substance,  when  the  peritoneum 
appeared,  the  recti  muscles  being  separated  by  the  distension 
consequent  on  the  present  disease  and  former  pregnancy.  I 
then  made  a  small  incision  through  the  peritoneum,  introduced 
a  straight  probe-pointed  bistoury,  and  made  a  more  extensive 
opening,  into  which  I  inserted  the  fore  and  middle  fingers  of 
the  left  hand,  so  as  to  direct  the  instrument,  and  to  protect  the 
viscera.  With  this  instrument  I  made  the  internal  to  correspond 
with  the  external  incision,  while  my  friend.  Doctor  Campbell, 
who  assisted  me,  endeavored,  but  in  vain,  to  confine  the  intestines 
within  the  abdominal  parietes.  Apprehensive  of  peritoneal 
inflammation,  of  which  many  said  my  patient  would  die,  I 
enveloped  the  intestines  in  a  towel  dipped  in  water  about 
98  degrees.  I  now  proceeded  to  examine  the  state  of  the  tumor 
when,  to  my  astonishment,  I  could  find  none.  I  next  requested 
Doctors  Campbell,  Vallange,  and  Bourchier,  to  make  themselves 
satisfied  that  there  was  no  tumor ^  when  Doctor  Vallange  observed 
that  he  felt  a  tumefaction  on  the  left  side  of  the  pelvis.  This,  on 
investigation,  was  found  to  be  a  flattened  tumor  of  no  great 
magnitude,  at  the  left  sacro-iliac  synchondrosis  of  the  pelvis, 
lying  beneath  the  division  of  the  common  iliac  artery,  into  its 
external  and  internal  branches.  Having  satisfied  all  present 
7  97 


EPHRAiM  McDowell 

that  this  was  not  the  tumor  which  was  anticipated — that  it 
was  impracticable  to  extirpate  it — and  that  the  uterus  and 
ovaria  were  perfectly  sound  and  healthy,  I  proceeded  to  return 
the  intestines,  and  to  stitch  up  the  wound,  carrying  the  needle 
as  deep  as  possible,  and  applying  straps  of  adhesive  plaster 
between  the  stitches.  Compresses  of  lint  were  next  laid  along, 
and  the  nine-tailed  bandage  bound  round  the  body.  I  then 
carried  her  to  bed,  and  gave  her  an  anodyne  draught  of  forty 
drops  of  laudanum,  which  was  almost  immediately  rejected. 
Ordered  her  warm  toast  and  tea. 

When  the  intestines  protruded,  and  baffled  all  the  efforts  of 
Doctor  Campbell  and  the  other  gentlemen  to  confine  them,  I 
shall  never  forget  the  countenances  of  my  pupils  and  the  younger 
members  of  the  profession.  This  fact  of  the  intestines  being 
forced  out,  proves,  along  with  others,  that  the  lungs  can  be 
expanded  although  atmospheric  air  be  admitted  into  the  ab- 
dominal cavity;  the  diaphragm  acted  with  great  vigour  and 
with  powerful  impetuosity.  The  operation  was  performed  at 
one  o'clock  of  the  day,  and  by  seven  in  the  evening  she  had 
vomited  twice;  had  flying  pains  in  the  abdomen,  a  little  hurried 
breathing,  pulse  at  loo,  and  some  thirst;  she  also  felt  uneasiness 
from  inability  to  void  her  urine,  which  was  drawn  off  by  the 
catheter;  and,  as  a  precaution,  I  bled  her  to  syncope,  which 
occurred  when  eleven  ounces  were  abstracted.  She  lost  little 
or  no  blood  during  the  operation.  An  anodyne  draught  was 
given  her,  which  was  again  vomited.  Thursday  morning,  she 
had  little  or  no  sleep,  still  flying  pains  about  the  abdomen, 
particularly  in  the  wound,  with  hurried  breathing,  and  the 
pulse  at  the  same  rate;  the  skin  felt  hot,  and  the  tongue  was 
white  and  a  little  crusted,  so  that  I  repeated  the  bleeding  to 
syncope,  which  occurred  when  thirteen  ounces  were  withdrawn. 
After  the  bleeding  she  felt  easier,  and  by  the  evening  these  symp- 
toms had  disappeared.  I  ordered  her  five  drops  of  the  sedative 
solution  of  opium,  which  remained  on  the  stomach,  but  produced 
no  sleep;  I  allowed  only  toast,  water,  tea,  coffee,  and  gruels, 
warm.  On  Friday  morning  she  felt  much  better;  was  pained 
only  once  in  the  hour  or  so,  her  breathing  was  natural,  her  pulse 
90,  and  soft,  her  skin  cool  and  soft,  and  her  tongue  white  and 
moist.  The  urine  still  required  the  employment  of  the  catheter. 
The  same  low  diet  continued.    At  bedtime  the  sedative  solution 

98 


THE  CONTRIBUTION  OF  JOHN  LIZARS 

was  increased  to  seven  drops.  Saturday  morning,  had  a  toler- 
able night,  and  felt  considerably  better;  felt,  however,  a  little 
uneasiness  in  the  wound,  which  has  not  troubled  her  since. 
Thursday  morning;  her  pulse  was  85,  and  soft,  the  skin  natural, 
and  tongue  cleaner.  Felt  a  little  appetite,  and  took  some  ground 
rice  with  sugar.  Today  I  dressed  the  wound,  and  found  the- 
line  of  incision  united  from  the  one  end  nearly  to  the  other;  at 
the  pubes  there  was  a  small  portion  everted;  the  adhesive  straps 
were  renewed,  but  the  stitches  were  allowed  to  remain.  She 
was  allowed  panada,  rice-pudding,  or  oatmeal  porridge.  At 
eight  in  the  evening,  she  felt  acute  pain  in  the  right  iliac  region, 
darting  upwards;  her  pulse  was  108,  full  and  strong;  the  skin 
hot,  and  some  thirst.  I  therefore  bled  her  to  fainting,  which 
followed  after  sixteen  ounces  were  abstracted.  In  an  hour 
after  a  domestic  enema  was  administered,  and,  lastly,  the  seda- 
tive solution  of  opium.  The  enema  operated  well,  and  she  fell 
asleep.  Sunday  morning,  after  a  good  night,  she  felt  greatly 
better;  no  pain  of  wound  or  abdomen,  no  thirst,  and  her  pulse  90, 
and  soft,  her  skin  cold,  and  tongue  much  cleaner.  The  wound 
was  dressed  and  two  stitches  withdrawn.  She  was  able  this 
morning  to  make  water  naturally;  in  the  evening  she  became 
uneasy,  the  enema  was  repeated,  and  the  opiate  omitted.  Mon- 
day morning,  had  rested  indiiferently,  and  her  pulse  was  100, 
and  feeble;  skin  rather  hot,  but  tongue  cleaner.  Pressure  on 
the  abdomen  gave  no  pain.  The  wound  was  dressed,  and  all 
the  stitches  were  withdrawn.  An  enema  of  castor  oil  was 
administered.  Desired  to  have  the  oatmeal  gruel  acidulated  with 
the  supertartrate  of  potass.  At  three  p.m.  the  enema  had  not 
operated,  so  that  she  was  ordered  two  drachms  of  supertartrate 
of  potass  mixed  with  treacle,  every  two  hours,  till  it  should 
operate.  By  eight  p.m.  the  enema  had  operated,  and  brought 
away  some  feces,  which  gave  her  great  relief.  The  pulse  was  112, 
her  skin  and  tongue  natural,  and  quite  free  from  pain.  The 
supertartrate  of  potass  continued.  Tuesday  morning,  although 
she  had  slept  well,  and  the  physic  had  operated  twice  in  the 
morning,  the  tongue  and  skin  natural,  and  was  perfectly  free 
from  pain,  yet  the  pulse  was  still  112.  The  wound  dressed; 
little  or  no  discharge,  and  chiefly  from  the  everted  edge  at  the 
pubes.  Ordered  veal  broth  for  dinner.  Wednesday,  eight  days 
from  the  operation,  had  slept  soundly;  was  free  from  pain; 

99 


EPHRAiM  McDowell 

tongue  and  skin  natural,  and  pulse  down  to  ninety-six,  and  soft. 
Ordered  veal  or  chicken  broth.  She  continued  daily  to  recover 
from  this  day  to  Sunday,  when,  although  the  bowels  have  been 
carefully  attended  to,  both  by  laxatives  and  enemata,  yet  they 
felt  so  distended  as  to  excite  much  uneasiness  and  irritation. 
An  enema  was  administered  in  the  morning,  and  she  took  five 
grains  of  calomel,  and  in  two  hours  after,  half  an  ounce  of  the 
phosphate  of  soda;  both  of  which  producing  no  effect,  the  latter 
was  repeated  after  two  hours  had  elapsed.  In  the  evening 
another  enema  was  administered,  which,  as  in  the  morning, 
brought  away  a  considerable  quantity  of  feces,  but  without 
relief.  Two  aloetic  pills  were  therefore  given  every  three 
hours,  till  six  were  swallowed,  when  no  motion  having  been 
produced,  a  drop  of  the  oil  of  croton  was  given,  which  in  half 
an  hour  excited  vomiting.  One  cathartic  enema  after  another 
was  given,  till  a  profuse  quantity  of  feculent  matter  was  dis- 
charged, and  then  she  felt  relieved.  From  this  day  she  gradually 
recovered,  without  any  untoward  symptom;  sat  up  out  of  bed 
on  Wednesday,  fourteen  days  after  the  operation,  and  went  to 
the  country  on  Saturday  the  i6th  October.  She  now  lives  in 
town,  earning  her  livelihood  as  formerly,  by  binding  shoes,  but 
is  often  severely  tortured  with  pain. 

The  reason  why  all  of  us  were  deceived  in  this  woman's 
case  was,  the  great  obesity  and  distended  fulness  of  the  Intes- 
tines, together  with  some  protrusion  pubic  of  the  spine  at  the 
lumbar  vertebrae.  This  did  not  at  all  appear  conspicuous  before 
operating,  otherwise  It  should  and  must  have  struck  some  of 
the  medical  gentlemen  who  examined  her;  nor  did  it  occur  to 
myself  during  the  operation,  nor  until  some  time  after,  when  I 
could  find  no  just  cause  for  being  so  singularly  deceived. 

From  this  case,  and  those  which  I  have  enumerated,  it 
appears  to  me  that  there  is  little  danger  to  apprehend,  in  laying 
open  the  abdominal  cavity;  and  that  in  diseased  ovarium,  extra- 
uterine conceptions,  foetus  In  utero  with  deformity  of  the  pelvis 
preventing  embryulcia,  aneurism  of  the  common  iliac  arteries 
or  of  the  aorta,  volvulus,  internal  hernia,  cancer  of  the  uterus, 
and  foreign  bodies  In  the  stomach  threatening  death,  we  should 
have  recourse  early  to  gastrotomy.  The  delay  in  such  cases  is 
more  dangerous  than  the  operation.  To  show  what  freedom 
may  be  used  in  diseased  ovarium,  I  have  received,  since  writing 

100 


THE  CONTRIBUTION  OF  JOHN  LIZARS. 

the  above,  the  following  history  of  a  case  from  my  friend    Mr. 
Edward  Scudamore,  surgeon  of  Wye,  in  Kent. 

In  1 82 1,  A.  C,  thirty-six  years  of  age,  had  been  repeatedly 
the  subject  of  paracentesis  abdominis  for  ovarian  or  encysted 
dropsy,  when  fluid  in  increased  quantities,  and  varying  in  qual- 
ity in  each  operation,  was  drawn  off.  Her  health  declining,  and 
her  constitution  resisting  such  effort  to  cure  the  disease,  any 
proposition  holding  out  the  most  remote  hope  was  eagerly 
listened  to.  The  trocar  and  canula  were  again  introduced,  the 
fluid  drawn  off,  and  the  canula  left  with  a  plug  inserted  in  its 
mouth.  In  a  few  days  the  plug  was  removed,  and  the  accumu- 
lated fluid  discharged,  which  operation  was  repeated  for  several 
successive  times,  after  eight  days  interval  between  each.  These 
attempts  proving  fruitless,  and  no  irritation  being  produced  by 
the  canula,  diluted  port  wine  was  injected  in  one  instance,  and 
a  solution  of  sulphate  of  zinc  in  the  other;  both  of  which  merely 
produced  a  sensation  of  heat  while  they  remained  in  the  cavity. 
Many  weeks  elapsed  after  these  operations,  when  the  constitu- 
tion gradually  sinking,  she  expired. — Edinburgh  Med.  Journal, 
Oct.,  1824,  vol.  xxii. 

If  the  above  was  considered  the  correct  form  in  which 
to  report  such  cases,  is  it  to  be  wondered  at  that  they 
suspected  McDowell's  simple  and  direct  statement  al- 
though it  harmonized  so  beautifully  with  his  simple  and 
direct  action? 

Through  Lizars'  paper  an  interesting  background  is 
supplied  to  McDowell's  achievements.  Involuntarily  two 
pictures  loom  up  in  our  imagination.  In  the  one  we  see 
the  simple  country  doctor,  virtually  alone  in  the  wilder- 
ness, relying  wholly  upon  his  "mother  wit,"  his  clear  and 
firm  grasp  of  the  principles  of  surgery  as  they  then  existed 
in  their  comparatively  simple  state,  and,  lastly,  a  degree 
of  courage  and  modesty  that  exists  only  in  a  really  great 
man.  Practically  alone,  disregarding  the  misgivings  of 
his  nephew  and  partner.  Dr.  James  McDowell,  who  was 
to  assist  him,  he  faced  the  task  with  clearness,  simplicity, 

101 


EPHRAiM  McDowell 

and  courage.  The  result  of  this  task,  so  simply  and 
quietly  performed,  which  was  destined  to  emancipate 
countless  millions  of  his  fellow  creatures  from  suflFering, 
and  premature  death,  and  which  in  time  would  add  cen- 
turies to  the  sum  total  of  human  life  he  recorded  in  an 
equally  simple  and  quiet  manner,  that  was  so  out  of 
proportion  to  its  importance,  that  it  aroused  distrust 
and  derision. 

In  the  other  picture  we  see  a  teacher  of  anatomy  and 
physiology,  in  the  very  atmosphere  of  what  was,  at  that 
time,  one  of  the  most  noted,  if  not  the  most  noted  uni- 
versity in  the  world,  confronted  with  what  he  believed 
to  be  a  similar  task.  Surrounded  by  all  the  aids  and 
advice  which  such  a  center  as  Edinburgh  then  afforded, 
and  which  he  freely  made  use  of,  Lizars,  with  trepida- 
tion, in  the  presence  of  an  audience  of  students  and 
physicians,  attempted  to  repeat  what  the  country  doctor 
fourteen  years  before  him  had  four  times  successfully 
carried  out. 

Lizars  failed  in  his  diagnosis,  as  the  operation  revealed 
the  absence  of  any  tumor.  And  the  report  of  this  failure 
was  as  conspicuous  through  the  presence  of  its  detail, 
as  McDowell's  report  was  conspicuous  because  of  the 
absence  of  detail.  If  Lizars'  failure  was  entitled  to  such 
detailed  consideration,  it  is  no  wonder  that  the  simple 
and  direct  statements  of  McDowell  should  have 
aroused  suspicion. 

Lizars*  paper  was  somewhat  inaccurate  and  was  lack- 
ing in  ethical  propriety.  A  more  careful  consideration  of 
the  case  of  L'Aumonier  should  at  that  time  have  satisfied 
a  man  of  Lizars'  ability,  just  as  it  satisfied  Gross  a  few 
years  later,  that  the  case  of  L'Aumonier  was  not  an  ovari- 
otomy, but  an  abscess  following  parturition,  that  was 
cured  through  drainage.    Moreover,  from  the  matter-of- 

102 


THE  CONTRIBUTION  OF  JOHN  LIZARS. 

fact  manner  in  which  Lizars  incorporated  McDowell's 
paper  in  his  own,  with  but  a  scant  acknowledgment  of 
such  an  epoch-making  contribution,  he  exposed  himself 
to  the  possibility  of  well-merited  criticism.  Judging  the 
paper  from  an  ethical  standpoint,  it  was  far  from  yielding 
to  McDowell  the  credit  which  he  deserved.  Since  Lizars 
had  but  a  failure  to  report,  as  no  tumor  was  found,  the 
very  title,  "Observations  on  Extirpation  of  the  Ovaria, 
with  Cases,  by  John  Lizars,  etc.,"  becomes  questionable. 

Why  Professor  Alexander  Russell  Simpson  (  The  British 
Medical  JournaU  November  5, 1887,  ),  in  referring  to  the 
fate  of  McDowell's  paper,  in  falling  into  Lizars'  hands, 
should  feel  justified  in  saying,  "It  could  not  have  fallen 
into  better  hands,"  we  are  unable  to  say. 

McDowell,  in  the  hands  of  Lizars,  received,  considering 
the  importance  of  his  communications,  as  scant  a  courtesy 
and  as  shabby  a  treatment  as  it  was  possible  to  accord 
him,  without  resorting  at  once  to  his  complete  obliteration. 
Although  McDowell's  report  was  buried  in  Lizars*  own 
paper,  after  remaining  for  seven  years  unpublished,  it^did 
not  escape  notice,  but  aroused  the  ire  of  Doctor  Johnson, 
whose  vicious  attacks  only  helped  to  bring  it  to  the 
attention  of  the  profession  abroad,  and  thus,  reflexly, 
America  was  at  last  awakened. 

About  the  same  time  that  McDowell  sent  the  copy  to 
Bell,  which  fell  into  Lizars'  hands,  he  sent  another  copy 
to  Dr.  Philip  Syng  Physick  of  Philadelphia,  with  the 
modest  request  that  "it  be  published  if  found  worthy." 

Although  it  was  perfectly  natural  for  McDowell  to 
send  his  first  communication  to  Physick,  whose  profes- 
sorial capacity  and  standing  as  a  surgeon  should  have 
made  him  a  peculiarly  fitting  subject  to  receive,  and  to 
transmit  this  epoch-making  contribution  to  the  medical 
profession,  McDowell  could  hardly  have  made  a  worse 

103 


EPHRAiM  McDowell 

selection.  Temperamentally,  Physick  was  in  no  way 
suited  to  assume  this  historic  role.  Unapproachable, 
unsympathetic,  and  mechanical,  he  lived  and  worked 
more  like  a  machine  than  a  plastic  human  being  whose 
thoughts  oscillated  with  every  influence  to  which  his  mind 
was  subjected.  Exactly  what  happened  when  William 
McDowell  offered  his  uncle's  modest  contribution  to 
"The  Father  of  American  Surgery,"  with  the  inoffensive 
request  that  it  be  published  if  found  worthy,  we  do  not 
know,  but  from  the  result,  we  feel  safe  in  suspecting  that 
Physick  thought  that  he  could  not  afford  to  take  any 
chances  with  a  country  doctor  who  was  doing  impossible 
deeds  under  impossible  circumstances. 

Physick,  who  was  styled  "The  Father  of  American 
Surgery,"  was  a  member  of  a  prominent  Philadelphia 
family.  He  received  in  early  life  a  precise  training  that 
left  nothing  to  the  imagination.  This  environment  re- 
sulted in  the  formation  of  one  of  those  eminently  correct 
characters,  who  take  no  chances  with  the  unconventional, 
and  whose  opinion  is  the  last  word  on  any  subject  that 
may  be  so  favored  as  to  receive  their  consideration.  He 
was  punctilious,  plodding,  and  conscientious,  but  with 
it  all,  reserved,  coldly  intellectual,  and  eccentric. 

Physick  was  born  in  Philadelphia  on  July  7,  1768,  and 
died  in  his  native  city,  December  15,  1837 — in  his  70th 
year.  He  was  the  son  of  Edmund  Physick  and  Abigail 
Syng  Physick.  His  father,  who  was  an  Englishman,  held 
office  in  the  Colonial  Government  as  Keeper  of  Its  Great 
Seal,  and  after  the  Revolution,  was  manager  of  the  Penn 
estate.  He  received  a  most  careful  training  here  and 
abroad,  and  was  a  pupil  and  an  assistant  of  John  Hunter. 
A  few  years  after  his  return  he  became  professor  of  surgery 
in  the  University  of  Pennsylvania.  Later  he  was  trans- 
ferred to  the  chair  of  anatomy. 

104 


PHILIP  SYNG  PHYSICK 

With  his  prestige,  and  his  earnest  and  plodding  work 
as  a  teacher  in  a  great  university,  covering  in  all  a  period 
of  about  a  quarter  of  a  century,  he  was  able  to  influence 
markedly  the  practice  of  surgery  in  this  country  as  it 
existed  in  his  time.  During  his  long  and  active  career, 
he  made  many  suggestions  and  practical  contributions 
to  the  art  of  surgery.  But  since  he  was  not  inclined  to 
write,  the  best  part  of  his  labors  was  lost.  Had  he  per- 
mitted the  pubHcation  of  his  notes  and  lectures,  which 
were  delivered  from  manuscript,  his  influence  would  have 
continued  after  him,  and  posterity  would  then  have  been 
able  to  reach  a  more  accurate  estimate  of  the  importance 
of  his  work. 

His  life,  in  a  way,  was  a  rather  melancholy  story,  for 
he  was  more  or  less  racked  with  illness,  despite  which 
he  continued  to  labor  practically  to  the  end.  With  an 
undeveloped  social  side,  he  spent  many  of  his  spare 
moments  in  introspective  solitude.  From  his  precise 
testamentary  directions  for  the  disposal  of  his  body  after 
death,  it  is  evident  that  the  eccentricities  of  the  middle 
period  of  his  life,  gradually  gave  way  to  a  condition  bor- 
dering on  mental  decline  in  his  old  age.  His  career 
afforded  him  abundant  honors  and  esteem  here  and 
abroad,  and  he  was  rated  among  the  wealthy  of  his 
native  city. 

In  a  pen  picture  in  the  American  Medical  Biography, 
Gross  describes  him: 

High  forehead,  aquiline  nose,  thin  and  compressed  lips,  a 
finely  formed  mouth,  and  hazel  eyes  with  their  searching  and, 
at  times,  penetrating  gaze.  The  complexion  was  one  of  ex- 
treme paleness. 

The  style  of  dress  worn  by  Doctor  Physick  showed  the 
methodical  man,  who,  while  he  adhered  to  the  same  color  and 
very  much  to  the  same  fashion  of  his  garments,  was  always  atten- 

105 


EPHRAiM  McDowell 

tlve  to  neatness  and  general  harmony  of  effect.  A  blue  coat  with 
metal  buttons,  white  waistcoat,  and  light  gray  or  drab-colored 
pantaloons,  made  up  his  favorite  attire.  It  must  have  been  in 
his  dancing  days,  when  he  was  seen  with  breeches  and  flesh- 
colored  silk  stockings.  The  bow-knot  in  his  cravat,  though  it 
might  fall  short  of  dandy  requirements,  evinced  care  in  its 
adjustment.  His  hair  was  combed  backwards,  a  la  Chinoise, 
so  as  to  expose  completely  his  forehead,  while  serving  at  the 
same  time  to  give  it  the  appearance  of  greater  proportionate 
development.  He  was  among  the  last  to  abandon  the  use  of 
powder,  but  held  on  to  the  queue  as  long  as  he  lived. 

His  personal  habits  were  early  formed  and  never  underwent 
change.  As  Doctor  Horner  somewhat  quaintly  says:  "He  had 
passed  his  life  in  a  certain  diurnal  movement  and  rotation,  any 
deviation  of  which  put  him  to  inconvenience." 

After  his  meeting  v^ith  Physick,  William  McDowell 
took  his  uncle's  little  report  of  "Three  Cases  of  Extir- 
pation of  Diseased  Ovaria*'  and  moved  on.  Such  v^as 
the  first  reception  accorded  McDowell's  labors  in  his 
own  country. 

Following  this  unsuccessful  effort  with  Physick, 
William  McDowell  turned  to  Dr.  Thomas  C.  James,  who 
has  passed  into  history  as  the  modest,  amiable,  and  benevo- 
lent professor  of  midwifery  in  the  University  of  Pennsyl- 
vania, and  one  of  the  editors  of  the  Eclectic  Repertory. 
Professor  James  placed  confidence  in  McDowell  and  his 
nephew,  took  the  time  to  study  the  report,  communicated 
it  to  his  pupils,  who  received  it  with  applause,  and  then 
published  it  in  the  Eclectic  Repertory  and  Analytical 
Review.  For  this  historic  deed,  Professor  James  deserves 
to  be  rescued  from  the  comparative  obscurity  in  which 
the  passing  time  has  placed  him. 

James,  whose  full  name  was  Thomas  Chalkley  James, 
was  born  in  Philadelphia,  August,  1766.  His  paternal 
ancestry  was  Welsh,  and  both  sides  of  his  family  were 
connected  with  the  Society  of  Friends.     He  received  a 

106 


THOMAS  CHALKLEY  JAMES 

classical  education  at  the  "Friends'  School"  under  the 
tutelage  of  Robert  Proud,  the  historian. 

Under  the  direction  of  Dr.  Adam  Kuhn,  a  pupil  and 
friend  of  Linnaeus,  he  began  the  study  of  medicine.  He 
received  the  degree  of  Bachelor  of  Medicine  from  the 
University  of  Pennsylvania  in  the  year  1787,  and  was 
entered  in  1788  as  surgeon  on  board  the  ship  "Sampson" 
on  a  voyage  to  China. 

When  he  appeared  in  London,  in  1790,  he  came  in 
contact  with  his  fellow  student,  Philip  Syng  Physick,  who 
at  that  time  was  a  pupil  of  John  Hunter  at  St.  George's 
Hospital.  The  year  1791  and  part  of  1792  he  spent 
in  London,  receiving  a  practical  training  in  obstetrics, 
and  attending  lectures  at  St.  George's  Hospital.  In  the 
spring  of  1792  James  and  his  companion.  Dr.  J.  Cathrall, 
who  was  with  him  in  Canton,  together  with  Physick,  went 
to  Edinburgh.  David  Hosack  was  also  attending  lectures 
at  Edinburgh  at  the  same  time. 

McDowell  narrowly  missed  both  James  and  Physick, 
who  left  Edinburgh  probably  just  before  his  arrival,  as 
McDowell  began  his  university  course  in  1793,  and  they 
returned  to  Philadelphia  about  the  middle  of  the 
same  year. 

James  did  not  remain  to  graduate,  but  returned  to 
Philadelphia  in  the  summer  of  1793  in  time  to  witness 
the  ravages  of  the  yellow  fever  epidemic  of  that  year.  In 
1 8 10  he  was  elected  to  the  professorship  of  midwifery  in 
the  University  of  Pennsylvania,  which  chair  he  held 
until  1835.  He  had  decidedly  literary  tastes,  and  in  addi- 
tion to  his  famiHarity  with  Greek  and  Latin,  he  was  a 
good  German  and  French  scholar.  In  conjunction  with 
Hewson,  Parrish,  and  Otto,  he  edited  the  Eclectic  Reper- 
tory and  Analytical  Review^  in  which  McDowell's  two 
articles  appeared. 

107 


EPHRAiM  McDowell 

Hugh  L.  Hodge,  M.D.,  in  an  address  before  the  College 
of  Physicians,  on  the  life  of  Doctor  James  {Williams'  Med. 
Biography)^  pays  him  this  tribute: 

We  all  loved  and  respected  him.  It  could  not  be  otherwise. 
The  senior  members  of  this  college,  of  which  he  was  President, 
viewed  him  as  a  friend  and  brother,  who  had  always  been  their 
chosen  companion,  and  their  fellow  laborer  In  all  the  duties  of 
this  society,  and  of  the  profession  to  which  they  were  alike 
devoted.  The  younger  members  looked  on  him  with  love  and 
veneration,  for  he  had  been  their  medical  teacher,  their  friend, 
their  counsellor,  and,  as  far  as  practicable,  their  benefactor. 
His  example  had  always  been  presented  as  most  worthy 
of  Imitation. 

The  most  striking  trait  in  the  character  of  Doctor  James 
was  unfeigned  modesty  and  diffidence.  This  native  modesty, 
pervading  his  whole  Intellectual  and  moral  nature,  had  the 
most  decided  influence  on  his  professional  course,  and  on  his 
present  and  future  reputation. 

It  was  fortunate  that  WilHam  McDowell  turned  to 
Doctor  James,  who  received  him  with  all  the  kindly 
sympathy  for  which  he  was  noted,  and  who  extended  to 
McDowell  the  fullest  measure  of  confidence  and  respect. 


108 


CHAPTER  VI 

Mcdowell's    second    report — remarks    upon    Mcdowell's 

COURSE   OF   procedure — ^ANALYTICAL  TABLE   OF   HIS   CASES 

REPORT  OF  HIS  UNPUBLISHED  CASES — TOTAL  NUMBER  OF 

HIS    OVARIAN    OPERATIONS. 

Two  years  after  McDoweH's  first  report  followed  the 
second,  and  like  the  former,  it  appeared  in  the  Eclectic 
Repertory.  His  second  contribution  was  in  the  form  of 
a  letter  to  Doctor  James,  in  which  he  reviewed  the  two 
additional  cases,  and  answered  some  criticisms  upon  his 
first  paper, 

OBSERVATIONS  ON  DISEASED  OVARIA 
By  Ephraim  McDowell,  M.D. 

Sept.,  1819. 
Dear  Sir, 

I  am  induced  to  make  this  statement,  principally,  in  conse- 
quence of  the  observations  of  Doctor  Henderson,  which  appeared 
in  a  number  of  the  Repertory,  published  twelve  or  fifteen  months 
since;  on  ovarian  disease,  and  abdominal  steatoma. 

Since  my  former  communication,  I  have  twice  performed 
the  operation  of  excision;  which  cases  are  subjoined. 

I  shall  in  the  first  place  take  some  notice  of  the  remarks  of 
Doctor  Michener,  which  Doctor  Henderson  in  his  dissertation 
has  thought  worthy  of  notice.  The  number  of  the  Repertory, 
containing  the  above  mentioned  remarks,  I  have  unfortunately 
lost;  but  believe  that  I  remember  most  of  his  principal  stric- 
tures. In  the  first  case  related  by  me,  in  Vol.  vii,  the  Doctor 
appears  to  take  exception  to  the  length  of  the  incision,  by 
pointing  out  the  sentence  which  stands  thus:  "I  made  an  incision 
about  three  inches  from  the  musculus  rectus  abdominis  on  the 
left  side,  continuing  the  same  about  nine  inches  in  length."  As 
I  did  not  actually  measure  the  incision,  it  would,  perhaps,  have 
been  better  to  have  said,  an  incision  was  made,  about  three 
inches  to  the  left  of  the  musculus  rectus,  extending  from  the 
margin  of  the  ribs  to  the  os  pubis,  on  a  woman  whose  abdomen 

109 


EPHRAiM  McDowell 

was  distended  by  a  tumor  to  an  enormous  size.  He  likewise 
objects  to  the  parietes  of  the  abdomen  being  contused,  in  conse- 
quence of  the  tumor  resting  on  the  horn  of  the  saddle,  during 
the  patient's  journey  to  Danville.  Observing  that  the  "horn 
of  the  saddle  is  on  the  right  side,  and  the  tumor  was  on  the  left." 
Now,  with  all  due  deference  to  the  Doctor's  knowledge  in  sur- 
gery, and  the  structure  of  side  saddles,  I  think  it  would  not  be 
difficult  to  conceive,  that  a  tumor  weighing  upwards  of  twenty 
pounds,  would  fill  the  whole  abdomen,  and  although  attached 
to  the  left  ovarium,  the  weight  and  bulk  must  have  been  almost, 
if  not  quite  as  great,  on  the  right  side  as  on  the  left.  I  would 
observe  that  my  patient  was  a  woman  of  small  stature;  her 
abdomen  had  become  so  pendulous,  as  to  reach  almost  to  her 
knees;  the  size  of  the  tumor  was  ascertained  from  actual  weight. 
Had  the  left  side  of  the  abdomen  been  contused,  I  would  either 
have  delayed  the  operation  until  the  contusion  was  removed, 
or  operated  on  some  other  part.  I  never  have  been  of  opinion, 
that  bruised  flesh  would  heal  so  readily  as  sound;  which  matter 
I  esteem  of  essential  importance  to  success  in  this  operation. 
The  doctor  also  objects  to  another  assertion  in  this  case,  viz: 
"When  I  visited  her  on  the  fifth  day,  I  found  her  engaged  in 
making  her  bed."  .The  Doctor's  skepticism,  alone,  appears  to 
have  carried  him  through  the  statement,  and  I  am  surprised 
that  he  will  even  admit  the  fact  of  her  returning  home,  in  five 
and  twenty  days  after  the  operation,  on  horseback;  a  distance 
of  seventy  miles,  and  in  the  depth  of  winter. 

Doctor  Henderson  thinks  I  was  entirely  too  inconsiderate 
in  my  detail  of  the  cases  of  diseased  ovaria;  I  thought  my  state- 
ment sufficiently  explicit  to  warrant  any  surgeon's  performing 
the  operation  when  necessary,  without  hazarding  the  odium  of 
making  an  experiment;  and  I  think  my  description  of  the  mode 
of  operating,  and  of  the  anatomy  of  the  parts  concerned,  clear 
enough,  to  enable  any  good  anatomist,  possessing  the  judgment 
requisite  for  a  surgeon,  to  operate  with  safety.  I  hope  no  oper- 
ator of  any  other  description  may  ever  attempt  it.  It  is  my 
most  ardent  wish  that  this  operation  may  remain,  to  the 
mechanical  surgeon,  forever  incomprehensible.  Such  have  been 
the  bane  of  the  science;  intruding  themselves  into  the  ranks  of 
the  profession,  with  no  other  qualification  but  boldness  in  under- 
taking, ignorance  of  their  responsibility,  and  Indifference  to  the 

110 


MCDOWELL'S  SECOND  REPORT 

lives  of  their  patients;  proceeding  according  to  the  special  dic- 
tates of  some  author,  as  mechanical  as  themselves,  they  cut 
and  tear  with  fearless  indifference,  utterly  incapable  of  exer- 
cising any  judgment  of  their  own  in  cases  of  emergency;  and 
sometimes,  without  possessing  even  the  slightest  knowledge  of 
the  anatomy  of  the  parts  concerned. 

The  preposterous  and  impious  attempts  of  such  pretenders, 
can  seldom  fail  to  prove  destructive  to  the  patient,  and  dis- 
graceful to  the  science.  It  is  by  such  this  noble  science  has 
been  degraded  in  the  minds  of  many,  to  the  rank  of  an  art. 

No  case  of  diseased  ovaria  has  come  under  my  observation, 
similar  to  the  one  described  by  Doctor  Henderson.  The  tumor 
extracted  by  myself,  I  have  kept  by  me,  in  a  state  of  preserva- 
tion; they  have  been  submitted  to  the  inspection  of  most,  if 
not  all  the  physicians  who  have  visited  me.  Their  opinions, 
as  to  the  nature  of  the  disease,  have  all  accorded  with  my  own. 
In  our  most  scrupulous  examinations,  we  were  never  able  to 
discover  any  portion  of  the  tumors  to  be  of  a  natural  or  healthy 
structure;  the  whole  exhibition  was  that  of  a  morbid  undistin- 
guishable  mass,  which  myself  and  others  of  the  faculty,  who 
were  present  at  the  operations,  were  of  opinion,  had  once  been 
the  natural  ovaria;  in  as  much  as  no  ovarium  remained  on  the 
side  from  whence  the  tumor  was  extracted.  This  was  as  clearly 
evident  as  it  could  have  been  on  dissection  after  death;  my 
incisions  were  made  so  free  and  extensive,  that  I  have  always 
performed  every  part  of  this  operation  by  sight. 

Such  ovaria  as  I  have  described  as  dropsical,  contained  a 
gelatinous  fluid  in  a  sac  about  half  an  inch  in  thickness  and  of 
a  spongy  texture;  such  as  I  have  denominated  schirrus,  were 
of  a  spongy  texture  throughout,  and  somewhat  elastic.  Those 
affected  with  schirrus,  complained  of  lancinating  pains  in  the 
parts  affected;  which,  from  their  description,  were  similar  to 
the  pains  in  other  schirrous  glands.  The  dropsical  ovaria,  are 
attended  with  a  dull  pain,  and  produce  a  most  oppressive  sense 
of  weight  in  the  abdomen.  By  these  symptoms,  and  by  a  nice 
sense  of  touch,  the  species  may  generally  be  distinguished  from 
one  another.  How  to  distinguish  them  from  steatoma  and  other 
affections  which  those  organs  are  liable  to,  I  shall  not  pretend 
to  define,  nor,  in  the  present  state  of  knowledge,  do  I  think  it 
at  all  necessary;  nor  even  the  distinction  from  one  another. 

Ill 


EPHRAiM  McDowell 

Excision  I  esteem  less  perilous  than  any  other  mode  of 
treatment;  and  the  only  certain  cure  for  either  of  them.  For 
schirrus  and  steatoma,  no  other  relief,  within  our  knowledge, 
is  practicable. 

The  dropsical  ovaria  may  be  relieved  by  tapping  with  a 
large  trocar.  But  the  relief  is  only  temporary,  and  would  be 
attended  with  no  inconsiderable  danger.  Some  further  reasons 
for  my  aversion  to  the  trocar,  I  will  relate  hereafter. 

The  second  case  in  which  I  operated  for  diseased  ovaria, 
was  the  case  of  a  negro  woman  in  this  neighborhood.  On  expos- 
ing the  tumor  (as  related  in  the  Repertory,  vol.  vii)  it  adhered 
so  firmly  to  the  neighborkig  parts,  that  I  did  not  attempt  its 
extraction,  but  made  a  free  incision  into  it  with  the  scalpel, 
and  discharged  its  contents;  she  recovered  of  the  operation, 
and  I  thought  her  well  of  the  disease;  but,  she  informed  me  some 
short  time  since,  that  it  had  been  growing  for  the  last  twelve 
or  eighteen  months,  and  says  it  is  now,  about  the  size  it  was 
when  I  opened  her  six  years  ago. 

None  of  my  patients  have  been  able  to  give  me  any  satis- 
factory account  as  to  the  origin  of  the  disease;  with  some  it 
commenced  some  months  after  delivery.  The  first  supposed 
herself  pregnant,  and  went  on  to  make  the  necessary  prepara- 
tion for  her  lying-in;  the  time  for  her  delivery  being  protracted 
to  a  great  length,  and  her  anxiety  and  doubts  increasing,  I  was 
called  in,  and  immediately,  on  examination,  per  vaginam,  found 
she  was  not  with  child. 

CASE  I 

In  April,  1 8 17,  I  operated  on  a  negro  woman  from  Garard 
county;  extracting  a  schirrous  ovarium,  weighing  five  pounds. 
The  incision  was  made  near  the  linea  alba;  as  in  cases  formerly 
related,  I  tied  a  cord  firmly  round  the  ligament  attaching  it 
to  the  uterus,  and  cut  away  the  ovarium;  but  owing  to  the 
shortness  and  sponginess  of  the  part,  the  cord  slipped  off,  before 
I  laid  the  ovarium  out  of  my  hands,  and  a  profuse  discharge  of 
blood  took  place.  I  immediately  drew  the  uterus  to  the  external 
incision,  and  commenced  tying  up  the  bleeding  mouths  separ- 
ately. This  also,  in  consequence  of  the  diseased  state  of  the 
parts,  proved  only  of  partial  efficacy,  as  several  of  the  ligatures 
cut  through,  on  tying  them.  I  now  thought  it  all  over  with  my 
poor  patient,  but  arming  a  needle  with  a  strong  ligature,  I 

112 


McDowell's  second  report 

passed  it  round  the  ligament;  securing  it  in  its  place  by  taking 
several  stitches  over  its  surface  as  I  passed  it  round,  and  firmly- 
tied  it.  By  turning  her  nearly  on  her  stomach,  I  was  able  to 
get  most  of  the  blood  out  of  the  abdomen,  using  my  hand  to 
extract  the  coagulated  portion.  The  incision  was  then  closed 
by  the  interrupted  suture,  and  strips  of  adhesive  plaster.  She 
recovered  happily;  but,  I  am  told  her  health  is  not  good;  the 
account  of  her  was  awkwardly  given;  from  what  I  could  learn, 
her  complaint  is  hysterical.  This,  though  the  smallest  ovarium 
I  have  ever  extracted,  was  much  more  troublesome  to  the 
patient,  than  in  any  previous  case.  Besides  experiencing  severe 
lancinating  pains  in  the  parts,  she  was  seldom  able  to  discharge 
her  urine,  without  getting  almost  on  her  head,  in  consequence 
of  the  tumor  falling  down  into  the  pelvis,  and  compressing 
the  urethra. 

CASE  II 

A  negro  woman  from  Lincoln  county,  was  brought  to  me 
in  April,  i8i8,  supposed,  by  the  different  physicians  who  had 
attended  her,  to  be  affected  with  ascites;  she  had  been  under 
their  care  about  eighteen  months.  On  examining  her,  I  could 
very  plainly  discover  the  fluctuation  of  fluid  in  the  abdomen, 
and  for  some  months  administered  medicines  for  ascites,  with- 
out effect;  despairing  of  the  power  of  medicines,  I  at  length 
tapped  her,  and  discharged  thirteen  quarts  of  gelatinous  fluid, 
such  as  I  had  before  met  in  dropsical  ovaria,  of  so  thick  a  con- 
sistence, that  I  found  it  extremely  difficult  and  tedious  to  dis- 
charge it.  In  two  months  after,  I  found  it  necessary  to  tap 
again;  during  the  process  of  discharging  it  a  second  time,  the 
opening  was  frequently  stopped  by  viscid  portions  of  the  jelly, 
which  were  broken  by  introducing  a  probe;  when  the  abdomen 
was  pretty  well  evacuated,  I  discovered,  with  the  probe,  a  firm 
substance,  which,  on  minute  examination,  I  found  to  be  of 
considerable  size.  I  at  once  supposed  the  existence  of  a  drop- 
sical ovarium,  in  which  I  was  confirmed,  on  finding  the  uterus 
empty  by  examination  per  vaginam.  Some  months  after  she 
was  again  tapped;  at  which  time,  I  made  the  opening  large 
enough  to  admit  my  finger;  by  which  means,  I  was  able  to 
ascertain  the  nature  of  the  disease  beyond  a  doubt.  I  informed 
her  master  what  was  certainly  her  situation,  and  that  nothing 
but  excision  could  affect  a  cure.    My  advice  was  not  immedi- 

8  113 


EPHRAiM  McDowell 

ately  followed,  not  until  after  she  was  tapped  a  fourth  time;  a 
week  or  two  after  which,  she  was  brought  to  Danville,  to 
undergo  the  operation,  which  was  performed  May  ii,  1819. 
The  diseased  ovarium  being  on  the  left  side,  and  evidently 
dropsical;  the  incision  was  of  course  made  on  the  left  side.  On 
exposing  the  tumor,  it  was  found  to  adhere  to  the  parietes  of 
the  abdomen;  and  to  the  intestines,  by  slender  cords  which  were 
easily  separated  with  the  hand,  and  which  caused  a  slight 
effusion  of  blood.  To  the  uterus,  two  strong  ligaments  adhered; 
one,  the  natural  ligament,  attaching  the  ovarium  to  the  uterus, 
the  other,  an  artificial  one,  attached  to  the  fundus  uteri:  which 
appeared  to  be  composed  of  the  above  mentioned  slender  cords, 
compacted  together.  I  then  tied  fine  cords  of  silk  firmly  round 
each  of  these  ligaments,  discharged  the  contents  of  the  tumor, 
and  cut  it  away. 

There  were  sixteen  quarts  of  gelatinous  fluid  discharged 
from  the  tumor  and  abdomen.  The  dressings  and  precautions 
were  the  same  as  in  other  cases.  The  second  day  after  the 
operation,  she  was  affected  with  violent  pains  in  the  abdomen; 
together  with  an  obstinate  vomiting.  She  was  blooded  as 
copiously  as  her  strength  would  allow,  but  without  producing 
any  abatement  of  the  pain  or  vomiting.  On  the  third  day  she 
died.  On  examination  after  death,  the  uterus,  contrary  to 
expectation,  appeared  natural  and  uninflamed,  the  right  ovarium 
healthy,  the  silken  cords  were  securely  and  properly  fixed,  and 
not  in  a  situation  likely  to  injure  the  adjoining  parts.  Her 
death  had  proceeded  from  peritoneal  inflammation.  This 
membrane,  throughout  its  whole  extent,  appeared  greatly 
inflamed,  and  the  intestines  largely  inflated. 

I  was  assisted  in  this  operation  by  my  nephew.  Dr.  William 
A.  McDowell.  Doctors  Weizegar,  Tomlinson,  and  Horr 
were  present. 

On  examining  the  substances  we  had  removed,  the  contents 
of  the  sac  presented  a  variety;  different  portions  of  the  fluid 
were  of  different  colours;  semitransparent,  white,  brown,  and 
yellow.  There  was  also  contained  in  the  sac,  a  considerable 
quantity  of  hair;  which  grew  from  the  inner  surface.  Enveloped 
in  the  inner  substances  of  the  sac,  we  found  a  bone,  resembling 
very  much  in  shape  the  front  tooth  of  a  cow. 

From  the  circumstance  of  the  hair  and  bone,  one  or  two  of 

114 


MCDOWELL'S  SECOND  REPORT 

the  physicians  present,  were  inclined  to  believe  the  disease 
originated  from  an  extra  uterine  conception;  and  that  all  of 
the  foetus  had  been  absorbed,  save  the  hair  and  single  bone, 
which  was  found.  This  question  I  submit  to  the  faculty.  As 
for  myself,  I  think  it  as  reasonable  to  suppose,  the  hair  and 
bone  in  this  unnatural  situation,  was  the  result  of  a  morbid 
action.  She  had  been  delivered  of  a  child  two  years  before  the 
operation,  her  health  during  that  time  was  never  good,  but  she 
had  no  reason  to  believe  herself  pregnant;  and  if  it  were  the 
case,  I  doubt  whether  a  whole  foetus  could  be  so  nearly  absorbed 
in  two  years.  There  was  likewise  a  round  hole  in  the  sac,  which, 
from  the  levelled  appearance  of  its  edges,  appeared  of  long 
standing;  the  whole  was  about  the  size  of  a  musket  ball.  And 
there  is  no  doubt,  that  the  gelatinous  fluid  escaped  through 
this  aperture  into  the  abdomen.  This  ovarium,  when  brought 
into  view,  was  of  a  large  size;  which  Is  the  more  remarkable, 
when  we  consider  the  enormous  quantity  of  fluid  which  had 
been  drawn  off  at  different  times,  by  the  operation  of  paracen- 
tesis abdominis.  During  the  evacuation,  a  bandage  was  kept 
bound  tightly  round  the  abdomen;  and  considerable  pressure 
was  made  with  the  hands,  in  order  to  evacuate  its  whole  contents. 
In  an  attempt  to  draw  off  the  contents  of  such  a  tumor  with  the 
trocar,  it  would  be  impossible  to  perforate  all  the  vesicles;^  and 
such  only,  as  were  pierced,  would  discharge  their  contents. 
While  one  portion  of  the  vesicles  of  the  ovaria  would  discharge 
themselves  into  the  abdomen,  another  portion  would  remain 
diseased  in  the  original  way.  Thus  compounding  in  the  system 
two  of  the  most  deplorable  diseases  to  which  it  is  liable. 

Ephraim  McDowell. 

If  McDov/ell's  course  is  carefully  considered,  it  is  not 
so  much  one  of  indifference,  as  it  at  first  appears  to  be, 
nor  as  it  has  been  credited  with  being.  In  fact,  it  bears 
distinct  evidences  of  being  a  carefully  considered  plan  of 
action  throughout.     Although  he  was  inclined  to  attri- 

1  Doctor  James. 

That  this  is  the  structure  of  diseased  ovaria,  I  infer,  both  from  authorities, 
and  from  the  difficulty  in  discharging  their  contents.  I  have  ahvays  been 
under  the  necessity  of  introducing  my  hand,  and  raking  it  forth;  the  obstacle 
to  the  discharge  being  ahvays  a  membraneous  structure. 

115 


EPHRAiM  McDowell 

bute  some  of  his  success  in  the  first  case  to  his  good  for- 
tune, it  is  remarkable  how  soundly  and  accurately  his 
first  operation  was  carried  out. 

With  the  exception  of  the  location  of  the  incision  and 
the  treatment  of  the  ligatures,  the  basic  principles  of  the 
operation  remain  about  the  same  to-day  as  they  were  in 
his  first  operation.  Modern  surgery,  it  is  true,  has  added 
its  refinements,  but  the  principles  as  employed  by  the 
country  doctor  remain  virtually  unchanged.  In  his  first 
case  he  made  his  incision  three  inches  from  "Musculus 
Rectus  Abdominis"  on  the  left  side.  This  site  for  the  inci- 
sion appealed  to  him  no  doubt  because  of  its  directness. 
In  all  likelihood  this  was  over  the  most  prominent  point  of 
the  enlargement.  Therefore  it  was  only  natural  for  him 
to  attack  the  tumor  through  its  most  direct  approach-. 

Such  was  and  still  is  good  surgery  in  inflammatory 
affections  where  the  existence  of  pus  is  suspected,  and  for 
the  same  reason  it  probably  appealed  to  him  as  the  logical 
course  in  the  case  of  an  ovarian  tumor. 

He  soon  saw,  however,  that  notwithstanding  these 
apparent  advantages,  the  site  of  the  incision,  which  was 
over  the  most  prominent  point  of  the  enlargement,  was 
after  all  not  the  best,  and  without  waiting  for  this  im- 
provement in  the  technique  to  be  pointed  out  to  him  by 
others,  he  shifted  as  much  as  possible  to  the  median  line 
where  it  is  today  and  where  it  will  remain.  His  knowledge 
of  the  anatomy  of  the  abdominal  wall  soon  indicated  to 
him  that  this  change  in  the  location  of  the  incision  had 
many  advantages. 

We  may  say  the  same  of  his  disposal  of  the  ligatures. 
It  was  also  quite  natural  for  him  at  first  to  allow  the 
ligatures  to  remain  long,  and  to  be  removed  later  on 
through  attempts  at  traction.  This  was  a  common  prac- 
tice in  amputations  and  had  the  advantage  of  serving  as 

116 


MCDOWELL'S  SECOND  REPORT 

a  means  of  drainage.  As  in  the  case  of  the  incision,  its 
advantages  were  more  apparent  than  real;  and  he  was 
not  long  in  making  a  change  based  entirely  on  his  own 
experience  and  reasoning. 

When  he  reached  the  point  of  making  his  labors  known 
to  the  world,  he  displayed  good  judgment  in  waiting  until 
his  first  operation,  or  "experiment,"  as  he  not  improperly 
termed  it,  had  the  corroboration  of  two  additional  cases. 
His  directness  may  not  have  been  the  conventional  course, 
and  although  his  statement  was  somewhat  incomplete,  it 
had  simplicity  and  brevity  to  its  credit.  Compare,  for 
example,  the  simple  statement  of  McDowell  with  that 
of  Lizars,  which  may  be  taken  as  a  fair  specimen  of 
the  medical  literature  of  that  day. 

McDowell's  plan  in  publishing  this  was  to  give  it  to 
the  profession  of  Europe  through  Great  Britain,  and  to 
the  profession  of  his  own  country  at  the  same  time. 
This  we  must  admit  entitled  him  to  more  credit  than  he 
has  generally  received.  Had  John  Bell,  to  whom  it  was 
sent,  been  in  Edinburgh  at  the  time,  there  is  no  room  for 
doubting  that  his  attitude  toward  McDowell's  communi- 
cation would  have  been  different  from  that  of  Physick's 
attitude  on  this  side  of  the  Atlantic. 

Lizars  for  a  time  may  have  felt  uncertain  in  his  status 
towards  a  communication  that  was  addressed  to  another, 
who,  although  ill  in  another  land,  was  still  living.  Bell 
died  in  Rome  in  1820.  Through  the  accident  of  Bell's 
absence  seven  years  elapsed  before  the  publication  by 
Lizars  of  McDowell's  communication.  These  were  seven 
barren  years  for  McDowell's  achievement,  since  it  failed 
to  arouse  any  interest  during  these  years,  although  its  pub- 
lication was  promptly  carried  out  in  America  by  Doctor 
James,  to  whom,  as  we  have  said,  McDowell's  nephew 
turned  after  he  failed  to  interest  Doctor  Physick. 

117 


EPHRAiM  McDowell 

His  second  report  is  not  far  behind  the  first  in  its 
value  and  its  interest.  It  not  only  supplies  two  additional 
corroborative  cases,  but  in  his  reply  to  the  criticisms  made 
upon  his  first  paper,  he  reveals  to  us  his  true  conception 
of  surgery  as  it  should  be  practiced,  and  his  wholesome 
contempt  of  a  certain  class  of  surgeons  who  practice  it, 
but  fail  to  fulfill  the  demands  of  his  standards. 

His  views  upon  these  two  points  are  as  sound  today 
as  when  they  were  uttered.  They  are  so  epigrammatically 
expressed,  so  evidently  sincere,  and  so  typical  of  the 
loftiest  ideaHsm  in  surgery,  that  they  may  with  benefit  be 
incorporated  into  a  motto  for  the  guidance  and  the  inspi- 
ration of  those  who  follow  this  branch  of  the  healing  art. 

The  criticism.s  of  his  first  paper  that  are  entitled  to 
notice  are  those  in  which  Doctors  Henderson  and  Mich- 
ener  think  him  entirely  too  inconsiderate  in  the  details  of 
his  cases,  criticisms  not  entirely  without  foundation. 
McDowell  answered  these  with  the  same  simplicity  and 
directness  that  characterized  his  activities  as  a  surgeon. 

The  papers  of  both  Dr.  Ezra  Michener,  of  Philadelphia, 
and  Dr.  Thomas  Henderson,  of  Georgetown,  D.  C,  to 
which  McDowell  replied  in  his  second  communication, 
appeared  in  the  eighth  volume  of  the  Eclectic  Repertory^ 
in  the  year  1818.  The  tone  of  their  criticisms  can  be 
illustrated  by  the  appended  extracts: 

It  is  much  to  be  regretted  that  cases  so  interesting  to  the 
community  as  those  of  Doctor  McDowell's  and  as  novel  as 
interesting,  should  come  before  the  public  in  such  a  manner 
as  to  frustrate  the  intention  of  becoming  useful. 

Far  be  it  from  me  to  arraign  the  probity  of  Doctor 
McDowell.  If  the  cases  he  relates  are,  as  I  sincerely  hope 
them  to  be,  correctly  stated,  no  remarks  of  mine  can  detract 
from  his  merits.     {Michener.) 

That  which  was  believed  to  be  ovarian  disease,  was  proved 
not  to  be  so;  and  if  this  mode  of  investigation  was  more  attended 

118 


ojwjByw  J  .^  >■■   •  ttfyi  •■;•-     -.  '■JT^^g? — ■"  "  < -■  %>' 


ECLECTIC  REPERTORY 


ANALYTICAL  REVIEW, 


Medical  and  Philosophical. 


EDITED  BY  A  SOCIETY  OF  PHYSICIANS. 


••••" Api-  matiiiK 

More  modofjue Hob. 

Nulli3  unius  (lisciplinie  legibus  adstricti,  quibus  in  plii- 
UKophia  ncceseai-i'i  paremus,(iui<l  sit  in  quaquc  re  maxime 
probalule  scmpei'  rtquiremua. — Cir.     i 


VOL.  IX. 


PHILADELPHIA: 

PUBLISHED  BY  THOMaS  lX)BSO?f  AND  SON, 

AT  TH«  STONK  HOUSE,  NO.  41,   SOUTH  SRCOND  STREET 

Williiun  Frv^  Printer. 

1819. 


■-* 


Cover  page   of  the   Eclectic   Repertory   and    Analytical  Review,   in  which   McDowell 
published  his  two  reports. 


McDowell's  second  report 

to,  and  even  if  one  writer  in  the  Eclectic  Repertory,  Doctor 
McDowell  had  been  more  considerate  in  the  examination  and 
detail  of  his  cases,  and  with  all  due  respect  I  would  suggest 
that  it  is  still  his  duty  to  be  so  something  very  interesting  might 
have  been  presented  to  the  profession  on  this  subject.  {Henderson) . 

Much  as  we  may  commend  the  directness  and  sim- 
plicity of  McDowell's  statements,  it  cannot  be  denied 
that  his  reports  were  not  as  complete  as  reports  of  such 
a  radical  innovation  should  have  been,  even  in  that  period 
when  no  one  could  have  realized  their  full  importance. 
Hence,  these  extenuating  circumstances  should  not  be 
overlooked  in  our  judgment  of  the  critics  of  McDowell 
upon  this  particular  feature. 

McDowell's  conception  of  the  definition  of  a  surgeon 
and  his  proper  obligations  are  clear  and  concise. 

Any  good  anatomist,  possessing  the  judgment  requisite  for 
a  surgeon,  to  operate  with  safety.  I  hope  no  operator  of  any 
other  description  may  ever  attempt  it.  It  is  my  most  ardent 
wish  that  this  operation  may  remain,  to  the  mechanical  surgeon, 
forever  incomprehensible.  Such  have  been  the  bane  of  the 
science;  intruding  themselves  into  the  ranks  of  the  profession, 
with  no  other  qualification  but  boldness  in  undertaking,  ignor- 
ance of  their  responsibility,  and  indifference  to  the  lives  of  their 
patients;  proceeding  according  to  the  dictates  of  some  other 
author  as  mechanical  as  themselves,  they  cut  and  tear  with 
fearless  indifference,  utterly  incapable  of  exercising  any  judg- 
ment of  their  own  in  cases  of  emergency;  and  sometimes,  without 
possessing  even  the  slightest  knowledge  of  the  anatomy  of  the 
parts  concerned. 

The  preposterous  and  impious  attempts  of  such  pretenders 
can  seldom  fail  to  prove  destructive  to  the  patient  and  dis- 
graceful to  the  science.  It  is  by  such  this  noble  science  has 
been  degraded  in  the  minds  of  many  to  the  rank  of  an  art. 

That  the  author  of  these  lines  did  his  own  thinking  is 
obvious,  and  that  he  believed  reforms  were  necessary  then, 
as  they  are  today,  is  equally  true.     He  did  not  hesitate 

119 


EPHRAiM  McDowell 

to  express  his  views  freely,  but  he  did  refrain  from  intoler- 
antly compelling  their  acceptance.  He  may  be  referred 
to  as  a  tolerant  reformer,  in  contrast  to  some  reformers  of 
the  intolerant  type. 

That  he  made  a  study  of  ovarian  conditions,  carefully 
weighing  the  advantages  of  one  procedure  as  compared 
with  another,  is  fully  attested  to: 

Excision  I  esteem  less  perilous  than  any  other  mode  of 
treatment;  and  the  only  certain  cure  for  either  of  them.  For 
schirrus  and  steatoma,  no  other  relief  within  our  knowledge 
is  practicable. 

The  dropsical  ovaria  may  be  relieved  by  tapping  with  a 
large  trocar.  But  the  relief  is  only  temporary,  and  would  be 
attended  with  no  inconsiderable  danger.  Some  further  reasons 
for  my  aversion  to  the  trocar  I  will  relate  hereafter. 

It  is  to  be  regretted  that  we  are  denied  "some  fur- 
ther reason  for  my  aversion,"  which  he  promises  to 
relate  hereafter. 

To  promote  the  understanding  of  the  analytical 
tables,  pages  122  and  123,  a  few  explanatory  details  of 
the  cases  are  supplied. 

Case  L — The  tumor  was  very  Hkely  a  cyst  adeno- 
mata. The  solid  element  weighed  seven  and  one-half 
pounds.  This  was  evidently  too  much  weight  to  represent 
merely  the  sac  wall. 

Case  IL — In  view  of  the  frequency  of  fibroids  in  the 
negro  race,  and  the  intimate  connection  between  the  tumor 
and  the  uterine  fundus  and  the  bladder,  the  question  that 
arises  is  whether  or  not  this  was  a  uterine  fibroid  of  a 
sessile  nature.  The  escape  of  gelatinous  substance,  the 
quantity  of  which  he  fails  to  mention,  is  the  only  point 
in  the  report  that  would  make  one  hesitate  in  pro- 
nouncing it  a  uterine  fibroid.  The  advantages  of  the 
median  over  the  lateral  incision  probably  occurred  to 
him  in  this  operation. 

120 


MCDOWELL'S  SECOND  REPORT 

Case  IIL — Here  he  definitely  changed  his  technique, 
substituting  the  median  incision  for  the  lateraL  He  says, 
**As  it  adhered  to  the  left  side,  I  changed  my  plan  of 
opening,  to  the  linea  alba."  This  probably  was  not  the 
only  reason,  for  in  the  hne  just  above  he  says,  **It  could 
easily  be  moved  from  side  to  side,"  and  therefore  very 
likely  his  experience  in  the  second  case  suggested  the 
median  incision  as  more  advantageous.  The  incision  ex- 
tended from  an  inch  below  the  umbilicus  to  within  an 
inch  of  the  pubis.  This  was  inadequate,  so  it  was  enlarged 
by  cutting  to  the  right  of  theumbihcus  and  extending  it  two 
inches.    He  was  assisted  by  his  partner  Dr.  Wm.  Coffer. 

Case  IV. — ^Was  marked  by  troublesome  hemorrhage 
owing  to  the  slipping  of  the  ligature.  In  this  case  he  seems 
to  have  abandoned  the  long  ligature,  that  is,  he  cut  it 
short  and  closed  the  wound.  From  the  interference 
through  pressure  upon  the  urethra,  and  his  drawing  of 
the  uterus  to  the  external  opening  in  order  to  find  the 
bleeding  vessels,  and  his  difficulty  in  ligating  them,  it  is 
probable  that  the  tumor  was  a  uterine  fibroid  of  the 
pedunculated  type. 

Case  V. — She  was  the  mother  of  one  child,  and  was 
at  first  believed  to  be  a  case  of  ascites  by  those  who  pre- 
ceded McDowell,  and  also  by  McDowell,  who  treated  her 
for  months  for  ascites,  and  later  tapped  her,  drawing  off 
thirteen  quarts  of  gelatinous  fluid.  She  was  tapped  in  all 
four  times,  and  in  the  third  tapping  he  made  an  incision 
large  enough  to  introduce  his  finger,  in  order  to  verify 
what  he  had  suspected  for  some  time,  and  what  was 
partly  verified  with  a  probe  at  the  second  tapping.  At 
the  operation,  adhesions  to  the  abdominal  parietes,  the 
intestines,  and  to  the  uterus  were  encountered.  In  this 
case  we  have  the  first  direct  statement  of  the  character 
of  ligature  he  employed — "fine  cords  of  silk." 

121 


EPHRAiM  McDowell 


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123 


EPHRAiM  McDowell 

There  can  be  no  doubt  that  in  this  case  he  cut  the 
ligatures  short.  In  the  course  of  the  operation  the  some- 
what unusual  quantity  of  sixteen  quarts  of  gelatinous 
fluid  was  removed  from  the  tumor  and  the  abdomen.  She 
died  on  the  third  day  from  post-operative  peritonitis.  It 
is  worthy  of  note  for  one  at  that  time,  and  situated  as 
McDowell  was,  to  follow  up  this  death  with  a  post-mortem 
examination.  The  case  proved  to  be  one  of  a  dermoid 
cyst.  The  soundness  of  his  reasoning  when  he  differed 
with  those  who  beHeved  it  to  be  a  case  of  extra-uterine 
conception,  in  which  every  portion  of  the  fcetus,  save  the 
hair  and  the  bone,  had  been  absorbed,  is  notable.  The 
free  gelatinous  fluid  in  the  abdominal  cavity  he  ascribed 
to  the  presence  of  a  perforation  about  "the  size  of  a 
musket  ball,'*  which,  from  the  appearance  of  its  edges,  he 
concluded  was  of  long  standing. 

A  tumor  of  such  a  description,  with  such  a  clinical 
history,  would  not  only  have  walls  that  had  undergone 
degenerative  changes,  but  the  previous  incision  made  at 
the  third  tapping  might  explain  the  opening  he  referred  to, 
or  might  be  responsible  for  a  tear  that  occurred  during 
the  operation,  possibly  while  separating  the  adhesions. 
His  assistant  was  Dr.  WiUiam  A.  McDowell.  The  specta- 
tors were  Doctors  Weizegar,  Tomhnson,  and  Horr. 

The  three  unpublished  cases  are  here  reproduced  in  the 
concise  form  in  which  they  appeared  in  the  Ridenbaugh 
biography,  from  the  more  extended  notes  supplied  by  Dr. 
S.  W.  Gross  in  his  Report  on  Surgery  to  the  Kentucky 
State  Medical  Society  held  in  Louisville,  October,  1852. 

Case  VL — Mrs.  O.,  of  Nashville,  Tennessee,  aged  fifty-five, 
and  inclined  to  corpulency.  She  first  noticed  (December,  1821) 
on  the  left  side  and  a  little  below  the  umbilicus,  a  small  globular 
tumor,  movable  from  side  to  side,  as  well  as  from  above  down- 
ward, destitute  of  sensibility,  and,  up  to  this  stage  of  the  growth, 

124 


HIS  UNPUBLISHED  CASES 

attended  with  but  little  inconvenience.  The  following  summer, 
however  (1822),  there  was  a  considerable  augmentation  in  the 
volume  of  the  growth,  with  corresponding  increase  of  discomfort, 
and  Doctor  McDowell  was  requested  to  visit  the  patient  at 
her  home  by  her  family  physician.  Dr.  James  Overton. 

Doctor  McDowell,  after  a  careful  examination  of  the  case, 
decided  upon  an  operation  for  the  removal  of  the  tumor.  He 
cautiously  made  his  median  incision  in  the  linea  alba  below  the 
umbilicus  and  over  the  most  prominent  part  of  the  growth, 
intending  to  extend  this  into  his  long  incision  above  the  um- 
bilicus in  order  to  facilitate  the  different  steps  of  the  operation. 
In  this,  however,  he  was  disappointed,  "for  he  had  no  sooner 
made  his  first  incision  through  peritoneum  than  there  gushed 
out,  in  a  full  stream,  a  bloody-looking  serum,  which  continued 
to  flow  till  the  sack  which  had  contained  it  was  apparently 
entirely  empty.    The  quantity  thus  lost  was  about  one  gallon." 

Judging  that  the  character  of  the  tumor  and  its  surroundings 
were  unfavorable  for  removal,  he  made  no  further  attempt  to 
complete  the  operation,  but  closed  the  incision,  leaving  a  tent 
in  its  lower  extremity  to  insure  drainage. 

"  The  patient  lived  from  fifteen  to  twenty  years  after  the 
operation,  enjoyed  excellent  health."  The  details  of  the  after- 
treatment  of  the  operation  were  furnished  Doctor  Gross  by 
Doctor  Overton. 

It  may  be  added,  as  of  historical  interest,  that  General 
Andrew  Jackson,  who  was  Mrs.  Overton's  neighbor,  was 
present  at  the  operation,  and  assisted  in  holding  her  hands 
and  supplying  her  with  courage. 

Case  VII. — Miss  Plasters,  May,  1823.  The  circumstances 
attending  this  case  were  furnished  Doctor  Gross  by  Dr.  W.  C. 
Gait,  of  Louisville,  Kentucky,  and  were  contained  in  a  letter 
received  by  the  latter  from  Doctor  McDowell.  An  abstract  of 
the  case  from  Doctor  Gross'  report  is  here  presented.  When 
the  patient  reached  Danville  to  consult  Doctor  McDowell,  the 
tumor  was  found  to  fill  the  entire  abdominal  cavity,  although 
it  had  been  tapped  only  three  months  previously.  She  was  so 
extremely  debilitated  that  he  believed  she  would  hardly  be  able 
to  sustain  the  shock  of  the  operation.    After  a  few  days'  rest, 

125 


EPHRAiM  McDowell 

however,  he  proceeded  to  make  his  usual  long  incision,  extending 
the  whole  length  of  the  linea  alba,  and  removed  the  tumor 
without  difficulty. 

The  pedicle  was  tied  and  the  wound  carefully  closed  in  the 
usual  manner.  Recovery  followed.  The  patient  duly  regained 
her  usual  health  and  spirits,  and  the  following  spring  (April, 
1824)  "engaged  herself  to  marry." 

Further  notes  upon  this  case  indicate  that,  "a  little" 
more  than  a  year  after  the  operation,  abdominal  dropsy- 
began  for  which  she  was  tapped.  She  then  disappeared 
from  Doctor  Gait's  observation.  Gross  refers  to  this  as 
McDowell's  ninth  case. 

The  sentiments  expressed  in  Doctor  McDowell's  letter 
to  Doctor  Gait,  written  some  time  after  the  operation, 
are  of  interest: 

This  case  proves  that  appearances  in  surgery  are  often 
deceitful,  and  that  while  the  taper  of  life  continues  to  burn, 
although  it  may  be  faint,  there  is  yet  hope;  for  Miss  Plasters 
has  certainly  disappointed  most  of  her  friends  and  all  that  saw 
her.    My  hopes  at  times  were  but  faint. 

"How  is  it?"  he  continued,  "that  I  have  been  so  peculiarly 
fortunate  with  my  patients  of  this  description,  I  know  not;  for, 
from  all  the  information  I  can  obtain,  there  has  not  one  indi- 
vidual survived  who  has  been  operated  on  elsewhere,  for  diseased 
ovaria.  I  can  only  say  that  the  blessing  of  God  has  rested  on 
my  efforts." 

{Transactions  Kentucky  State  Medical  Society ^  ^^S3-) 

In  his  statement  he  also  defines  his  attitude  towards 
unfavorable  cases.  He  felt  that  it  was  the  duty  of  the  sur- 
geon to  attempt  the  cure  or  relief  of  a  case,  however  forlorn 
in  appearance,  so  long  as  it  was  not  absolutely  hopeless. 

Surgery  is  for  the  cure  and  a  relief  of  the  afflicted,  even 
though  the  surgeons  record  may  be  punctuated  with  some 
deaths.  McDowell's  view  was  a  broader  and  more  gener- 
ous one  than  the  narrow  and  selfish  attitude  of  some 
surgeons  whose  chief  aim  is  to  have  a  brilliant  record 

126 


HIS  UNPUBLISHED  CASES 

through  the  denial  of  possible  relief  to  cases  because  of 
their  unfavorable  prospect.  In  the  words  of  Hufland,  "he 
looked  upon  his  profession  as  a  high  and  holy  office,  who 
exercised  it  purely,  not  for  his  own  advancement,  not  for 
his  own  honor,  but  for  the  glory  of  God  and  the  good  of 
his  neighbors." 

In  the  second  part  of  this  quotation  McDowell  refers 
to  the  success  which  he  is  more  inclined  to  explain  through 
the  blessings  of  God  than  through  his  own  judgment  and 
surgical  ability. 

Case  VIII.— Mrs.  Delano,  of  Chillicothe,  Ohio  (1826), 
aged  thirty-eight.  Her  case  will  also  be  presented  in  abstract 
from  Doctor  Gross'  report.  She  first  noticed  a  fullness  in  the 
right  side  of  her  abdomen  in  the  autumn  of  1822.  In  December, 
1825,  it  is  stated  "a  hard  tumor  was  discovered  in  the  right  ilio- 
hypogastric region,  which  has  steadily  increased  in  volume  and 
now  occupies  the  whole  abdominal  cavity,  from  the  pubic  sym- 
physis to  above  the  umbilicus,  reaching  outwardly  as  far  as  the 
costal  cartilages.  It  is  hard,  irregular,  slightly  movable,  and 
cannot  be  traced  under  the  ribs."  The  above  notes  were  made 
by  the  late  Dr.  Daniel  Drake,  of  Cincinnati,  October  24,  1826, 
when  the  patient  was  on  her  way  to  Danville  to  consult  Doctor 
McDowell.  On  her  arrival  there,  and  after  a  thorough  examina- 
tion of  her  case,  Doctor  McDowell  thought  it  possible  to  remove 
the  tumor,  notwithstanding  his  belief  that  extensive  adhesions 
existed.  He  accordingly  made  his  usual  long  incision  through 
the  linea  alba  and  exposed  the  tumor,  which  had  firm  adhesions 
with  the  omentum. 

After  fully  opening  the  peritoneal  cavity,  he  found  the 
adhesions  even  more  extensive  than  he  had  at  first  supposed. 
By  the  time  he  had  gotten  the  omentum  separated,  the  patient 
became  so  exhausted  that  the  operation  had  to  be  suspended, 
and  finally  it  was  abandoned  altogether.  The  wound  was 
immediately  closed  up,  and  in  about  two  weeks  it  had  entirely 
healed,  the  patient's  general  condition  seeming  to  be  very  much 
the  same  as  it  was  before  the  operation.  Doctor  Drake  saw 
this  woman  the  following  March  (1827),  and  "found  her  exces- 
sively emaciated,  with  swelling  of  the  right  leg  and  all  symptoms 

127 


EPHRAiM  McDowell 

of  gradual  exhaustion."    Death  took  place  soon  thereafter.     No 
autopsy  was  made. 

The  following  statement  is  made  in  a  letter  which  the 
husband  of  the  patient  wrote  to  Doctor  Drake  after 
reaching  Danville  and  interviewing  Doctor  McDowell: 

"I  learned  from  Doctor  McDowell,"  writes  the  husband  of 
the  lady,  "that  he  had  operated  for  diseased  ovaria  in  nine  or 
ten  cases,  in  eight  of  which  he  had  been  successful.  Some  of 
these,  I  believe,  were  of  that  character  termed  dropsy  of  the 
ovary,  the  tumor  consisting  of  a  sac,  enclosing  a  quantity  of 
liquid,  gelatinous  material;  in  the  other  cases  the  tumor  was 
solid,  and  appeared  to  be  composed  of  a  gristly,  cartilaginous 
substance.  In  every  instance  attended  with  success  the  tumor 
was  loose  and  floating,  except  in  one  or  two  cases,  where  it  was 
filled  with  water,  which  was  drawn  off,  the  sac  being  suffered 
to  remain.  In  every  other  case,  where  the  tumor  adhered,  the 
attempt  to  operate  was  unsuccessful;  or,  if  McDowell  succeeded 
in  extracting  the  morbid  growth,  as  he  probably  did  in  one 
instance,  the  patient  died." — {Gross'  Report  on  Surgery.) 

Doctor  Drake,  who  saw  the  patient  after  the  operation 
supplies  the  clinical  history  subsequent  thereto  in  the, 
appended  extract  from  Gross'  Report. 

Doctor  Drake  visited  Mrs.  Delano  on  the  nth  of  March, 
1827,  about  four  months  and  a  half  after  the  operation,  and 
found  her  excessively  emaciated,  with  swelling  of  the  right  leg, 
and  all  the  symptoms  of  gradual  exhaustion.  The  cicatrice, 
from  the  operation,  existed  in  the  linea  alba,  and  was  about  two 
inches  long.  The  whole  abdomen  was  excessively  protuberant, 
from  the  pubic  symphysis  to  the  ensiform  cartilage.  The  liver, 
very  hard  and  greatly  enlarged,  bulged  out,  high  between  the 
short  ribs,  and  the  umbilicus  over  into  the  left  side.  Here,  in 
contact  with  the  ovarian  tumor,  in  a  kind  of  groove  between 
them,  the  colon  was  a  small  flatish  tumor,  which  felt  very  hard, 
and  could  be  moved  along  the  bowel  down  into  the  sigmoid 
flexure.  The  ovarian  tumor  filled  the  right  iliac  region,  and 
extended,  in  front,  nearly  to  the  umbilicus,  crossing  the  linea 
alba  and  being,  seemingly,  more  prominent  on  the  left  than  on 

128 


HIS  UNPUBLISHED  CASES 

the  right  side.  It  was  fixed  during  respiration,  and  appeared 
to  be  immovable.  The  liver,  on  the  other  hand,  obeyed  the 
motions  of  the  diaphragm.  Her  menses  had  ceased  only  about 
three  months  ago.  Death  occurred  soon  after  Doctor  Drake's 
visit.    No  examination  of  the  body  was  made. 

A  review  of  the  eight  cases,  of  which  we  have  notes, 
five  of  which  he  published,  and  three  were  published 
later  by  Gross,  indicates  that  four  were  in  the  white  race, 
and  four  in  the  negro  race.  Of  the  five  cases  which 
McDowell  published,  four  were  negresses.  The  first  of 
these  eight  cases  was  operated  upon  in  1809,  and  the 
last  was  in  1826,  or  about  four  years  before  his  death, 
their  respective  years  being  1809-13-16-17-19-22-23-26. 
Five  of  these  eight  cases  were  complete  operations,  and 
three  were  incomplete.  There  was  one  death  in  the 
eight  listed  cases  as  the  result  of  the  operation. 

So  far  reports  have  been  obtainable  only  in  the  fore- 
going eight  cases;  these  can  hardly  be  considered  as  repre- 
senting a  full  list  of  his  ovarian  operations.  In  the  letter 
written  to  Doctor  Drake  by  Mr.  Delano  the  husband 
of  the  patient  represented  in  case  eight,  occurs  the 
statement:  "I  learned  from  Doctor  McDowell  that  he 
had  operated  for  diseased  ovaria  in  nine  or  ten 
cases,  in  eight  of  which  he  had  been  successful."  This 
letter,  which  deserves  consideration  on  account  of  its 
evident  consistency,  implies  that  up  to  that  date,  October, 
1826,  he  had  operated  upon  one  or  two  cases  not  included 
in  the  detailed  list.  Dr.  WilHam  A.  McDowell,  who 
was  a  member  of  his  uncle's  family  for  seven  years,  five  as 
student,  and  two  as  partner,  says  that  "he  has  reason  to  be- 
lieve from  reliable  testimony  that  his  uncle  performed  this 
operation  altogether  thirteen  times."  Since  Dr.  William 
A.  McDowell,  however,  fails  to  supply  any  evidence  other 
than  the  mere  mention  of  another  name,  that  of  a  Miss 

9  129 


EPHRAiM  McDowell 

Gilmore,  of  Pulaski  County,  the  accuracy  of  this  behef 
yet  remains  to  be  verified. 

In  the  Historical  Number  of  the  Ky.  Med.  Jour.,  Nov. 
I,  1917,  is  a  photographic  reproduction  of  a  letter  written 
by  McDowell  about  a  year  before  his  death  to  Mr. 
Robert  J.  Thompson,  who  was  then  a  medical  student 
in  Philadelphia.  In  this  letter,  after  some  stereotyped  re- 
marks upon  the  Crawford  case,  occurs  the  statement, 
"Since  that  time  (1809)  I  have  operated  eleven  times 
and  lost  but  one."  Further  on  occurs  the  following:  *'I 
last  spring  operated  upon  a  Mrs.  Byant  from  the  mouth 
of  the  Elkhorn  below  Frankfort.  I  opened  the  abdomen 
from  the  umbilicus  to  the  pubes  and  extracted  sixteen 
pounds.  The  sac  contained  the  most  offensive  matter  I 
ever  smelt.  She  is  now  living."  Towards  the  close  of 
his  letter  he  says,  "therefore,  it  appears  to  me  mere 
Humbug  about  the  Dangers  of  Peritoneal  Inflammation 
so  much  talked  about  by  most  surgeons."  The  letter  is 
dated  January  2,  1829,  and  the  above  operation  was  per- 
formed in  the  foregoing  spring,  making  it  in  the 
year  1828. 

If  we  accept  the  names  of  Miss  Gilmore  and  Mrs. 
Byant,  we  have  ten  cases  in  which  the  names  are  known. 
In  nine  of  these,  some  of  the  details  are  given,  leaving  the 
eleventh  and  twelfth  cases  without  names  or  any  details. 
Under  the  circumstances,  an  exact  statement  as  to  the 
number  of  his  operations  is  difficult  to  make,  and  hence 
an  accurate  estimate  of  his  mortality  becomes  impossible. 


130 


CHAPTER  VII 

THE   TRADITION  THAT  HIS   OPERATIONS   WERE   PERFORMED  UPON 

NEGRO  SLAVES REVIEW  OF  THE  ATTEMPTS  TO  DEPRIVE  HIM 

OF  HIS  HONORS ^THE  COMMENTS  OF  SIR  T.   SPENCER  WELLS. 

It  is  deserving  of  notice  that,  of  his  five  pubhshed 
cases,  all  except  the  first  were  negresses.  Very  likely, 
through  an  inattentive  consideration  of  his  writings,  the 
fact  that  his  first  operation  was  performed  upon  a  white 
woman  was  in  some  quarters  overlooked.  If  we  are  justi- 
fied in  our  belief,  this  error  led  to  the  deeply  rooted 
and  widely  distributed  tradition  that  not  alone  was 
his  first  case  a  negro  slave,  but  that  he  performed 
the  operation  upon  negro  slaves  only,  as  though  he  dared 
not,  or  could  not,  perform  the  operation  upon  white 
women.  As  we  carefully  explained  in  the  Foreword,  and 
here  reiterate,  it  was  this  misleading  impression,  so 
strikingly  brought  to  our  attention,  that  awakened  in 
us  an  interest  which  culminated  in  the  effort  which  this 
volume  represents. 

Owing  to  the  extent  to  which  this  tradition  has  spread, 
it  is  not  without  interest  to  attempt  to  trace  its  origin 
and  its  dissemination.  The  first  reference  that  we  have 
been  able  to  find  is  credited  to  Dr.  James  Johnson,  of  the 
Lon.  Med.  Chir.  Rev.,  who,  in  his  editorials,  so  relentlessly 
pursued  McDowell,  to  the  advantage  of  the  latter  and  the 
disadvantage  of  himself.    It  is  as  follows : 

When  we  come  to  reflect  that  all  the  women  operated  upon 
in  Kentucky,  except  one,  were  negresses,  and  that  these  people 
will  bear  cutting  with  nearly,  if  not  quite,  as  much  impunity 
as  dogs  and  rabbits,  our  wonder  is  lessened,  and  so  is  our  hope 
of  rivalling  Doctor  McDowell  on  this  side  of  the  Atlantic. — 
Ridenhaugh. 

131 


EPHRAiM  McDowell 

This  in  all  likelihood  occurred  in  1826.  Although 
Johnson  did  not  overlook  the  fact  that  the  first  operation 
was  performed  upon  a  white  woman,  it  was  probably 
through  a  careless  transmission  of  his  comment  that  this 
tradition  arose.  The  second  reference  that  we  encount- 
ered was  in  the  form  of  a  refutation  of  a  statement 
attributed  to  Nelaton,  in  which  he  is  represented  as  say- 
ing, in  effect,  that  the  first  operations  were  performed  upon 
negro  slaves  at  the  instance  of  the  slave  holder;  that  these 
operations  were  undertaken,  not  so  much  with  the  view 
of  reheving  human  suffering,  as  they  were  to  save,  if 
possible,  these  slaves,  who  constituted  valuable  assets; 
furthermore,  that  McDowell  utiHzed  these  negresses  in 
an  experimental  way  as  a  preliminary  to  the  establishment 
of  his  heroic  operation.  The  statement  adds  that  this 
view  has  in  recent  times  been  abandoned  in  America. 
The  reference  is  as  follows: 

Das  die  ersten  weiber  on  denen  er  die  Ovariotomie  vornahm 
Negersklavinnen  warden  und  er  die  operation  nur  liber  aufford- 
erung  der  Sklavenbesitzer  denen  es  sich  um  die  Erhaltung  des 
damals  kostspieligen  Sklavenmaterials  handelte  vornahm  wie 
dies  Nelaton  berichtet  ist  nicht  richtig.  Dieser  Vorworf  Nek- 
tons habe  diese  kranken  farbiegen  Weiber  nur  als  Versuchts- 
object  zur  Vornahmeseiner  hardiosen  operation  benurzt  wurde 
in  Amerika  in  neuster  Zeit  wiederlegt. — Biogr aphis ches  Lexikon 
Der  Hervorragenden  Aertzte  Alter  Zeiten  un  Vblker,  Vol.  11^ 
E.  Gurlt  and  Dr.  August  Hirsch. 

All  efforts  to  find  the  original  statement  which  Nelaton 
is  supposed  to  have  made  have  been  without  avail. 

The  third  and  last  expression  which  we  encountered, 
relating  to  this  part  of  the  story,  occurred  in  the 
Geschichte  Der  Neucren  Deutschen  Chirurgie,  von  Dr. 
Ernst  Kiister: 

Es  war  in  einem  einfachen  Holzhause  eines  Stadtchens  im 
Staate  Kentucky,  wo  der  in  England  vorgebildete  amerikanische 

132 


OPERATIONS  PERFORMED  UPON  NEGRO  SLAVES 

Arzt  McDowell  im  Jahre  1809  zum  erstenmal  die  Operation 
der  Oophorektomie  an  einer  Negerin  mit  Vorbedacht  ausfhiirte 
und  vollen  Erfolg  erzielte. 

From  these  references,  and  we  have  no  other  evidence 
to  guide  us,  we  are  disposed  to  conclude  that  the  myth 
had  its  origin  in  England  in  1826.  Very  likely  from  here 
it  became  modified  and  transmitted  to  France  by  Nelaton, 
sometime  before  1873,  for  in  that  year  the  great  French 
surgeon  died. 

It  appeared  in  1885, or  possibly  before  that  date,  in  Ger- 
many, in  the  form  of  a  refutation  of  Nelaton's  supposed 
statement.  No  further  reference  was  discovered  until 
191 5  when  we  again  observed  it  in  its  old  and  erroneous 
form,  and  coming  from  the  pen  of  such  a  well-known  au- 
thor as  Professor  Ernst  Kiister. 

The  attempts  to  dispossess  McDowell  of  his  justly 
earned  and  richly  deserved  honors  began  within  his  own 
circle  during  his  lifetime,  and  spread  beyond  the  Atlantic, 
with  but  very  little  abatement,  almost  to  the  present  day. 
His  claims  to  the  honor  of  the  first  ovariotomy  are  so 
clear,  and  so  unequivocal  that  it  seems  like  a  waste  of 
time,  to  refer  again  to  this  subject,  especially  since  it  has 
been  so  thoroughly  dealt  with  by  Gross,  Greig  Smith, 
and  others.  To  all  this  may  be  added,  that  if  the  services 
which  he  rendered  were  not  so  priceless  to  humanity,  and 
so  fruitful  to  his  profession,  we  might  now  be  tempted 
to  pass  over  them  in  silence.  Under  the  circumstances, 
however,  a  careful  review  of  these  attempts  is  fully 
justified. 

The  earliest  records  we  find  take  us  back  to  1826, 
which  was  shortly  after  Dr.  James  Johnson's  strictures. 
Possibly  Johnson's  criticisms  played  an  important  role  in 
developing  tendencies  that  up  to  that  time  existed  only 
in  a  latent  form. 

133 


EPHRAiM  McDowell 

In  that  year  McDowell  addressed  the  previously 
referred  to  card  to  the  "Physicians  and  Surgeons  of  the 
West,  and  particularly  to  the  Medical  faculty  and  class 
at  Lexington,"  in  defense  of  his  position.  This  card  was 
issued  to  disprove  the  claims  that  were  advanced  by  some 
that  the  first  ovariotomy  was  performed  by  his  nephew, 
Dr.  James  McDowell. 

In  commenting  upon  this  card  Gross  added: 

The  paper  from  which  I  have  read  the  above  extracts  is 
accompanied  by  three  certificates,  all  testifying  to  the  truth  of 
Doctor  McDowell's  statements.  One  of  these  certificates  is 
from  Mrs.  Crawford  herself;  another  from  her  nurse,  Mrs. 
Baker,  and  the  third  from  Mr.  Charles  McKinny,  a  private 
pupil  of  Doctor  McDowell,  who  with  Mrs.  Baker  witnessed  the 
whole  proceeding.  He  states,  expressly,  that  Dr.  James 
McDowell  made  the  external  incision  as  directed  by  his  uncle, 
and  that  then  the  latter  took  the  knife  and  extracted  the  diseased 
ovary.  He  asserts,  moreover,  that  he  never  heard  Dr.  James 
McDowell  claim  the  credit  of  the  operation.  When  we  add  to 
these  facts,  the  statement  of  Dr.  William  A.  McDowell,  that 
he  and  Doctor  Smith  both  assisted  Dr.  Ephraim  McDowell,  on 
several  occasions,  in  the  same  manner,  it  follows,  as  a  necessary 
corollary,  that  the  claims  set  up  in  behalf  of  Dr.  James  Mc- 
Dowell, who  is  said  to  have  been  a  young  man  of  great  profes- 
sional promise,  must  fall  to  the  ground  as  untenable. 

Who  started  this  report  will  never  be  known.  Most 
Hkely  it  did  not  originate  with  any  one  particular  person, 
but  was  more  or  less  the  spontaneous  outburst  of  several, 
and  represented  that  unfortunate  element  in  human 
nature  which  prompts  some  to  look  with  envy  upon  the 
honors  and  the  material  possessions  of  others.  Highly 
respected,  as  McDowell  was,  this  fact  did  not  protect  him 
or  even  his  family  from  calumnious  attacks.  Therefore, 
nothing  would  be  more  natural  than  that  these  attacks 
should  include  casting  suspicion  upon  his  claims  to  the 
first  ovariotomy. 

134 


ATTEMPTS  TO  DEPRIVE  HIM  OF  HIS  HONORS 

If  McDowell's  ovariotomy  was,  by  reason  of  its  mag- 
nitude and  importance,  received  by  many  in  various 
parts  of  the  world  as  an  unbelievable  performance,  what 
shall  we  say  of  the  assumption  that  Mrs.  Crawford,  after 
reaching  Danville,  would  select  or  permit  McDowell's 
nephew,  who  studied  under  his  uncle  and  had  graduated 
but  a  few  months  before,  and  who  was  entirely  without 
experience,  to  perform  the  operation  instead  of  McDowell, 
who  had  come  to  Green  county,  a  distance  of  about  sixty 
miles,  to  Mrs.  Crawford's  home  and  whose  consultation 
had  directly  resulted  in  her  coming  to  Danville? 

From  a  pamphlet  entitled  "A  Report  on  the  Improve- 
ments in  the  Art  and  Science  of  Surgery  in  the  Last  Fifty 
Years,  By  Joseph  N.  McDowell,  M.D.,  of  Saint  Louis, 
Missouri,  Read  Before  the  American  Medical  Association, 
Held  at  New  Haven,  Conn.,  June,  i860,"  the  following 
extract  was  taken : 

The  history  of  ovariotomy,  as  described  by  Doctor  Gross, 
may  be  in  many  respects  true,  as  far  as  he  knows,  but  never- 
theless, it  is  unjust.  I  hold  in  my  possession  testimony  which 
must  prove  satisfactorily  that  the  credit  of  the  first  operation 
does  not  belong  to  Dr.  Ephralm  McDowell,  but  to  others. 
In  1808  a  lady  of  Stanford,  Ky.,  called  on  Dr.  E.  McDowell, 
to  be  examined  and  operated  upon  by  him.  He  pronounced  it 
a  case  of  ovarian  disease,  and  told  her  it  was  incurable,  for  she 
must  eventually  die  by  the  bursting  of  the  tumor  in  the  abdo- 
men. She  returned  home  in  despair,  but  having  related  her 
case  to  an  old  Indian  hunter,  who  in  later  life  had  made  his 
living  by  spaying  animals,  he  proposed  to  cure  her  if  she  would 
submit  to  his  mode  of  operation.  She  said  it  was  but  death, 
and  she  would  try  it,  and  accordingly,  John  King  opened  the 
abdomen  as  he  would  that  of  a  sow  or  heifer,  and  the  tumor 
being  pedunculated,  he  passed  a  ligature  around  the  neck  and 
cut  it  off,  and  in  two  weeks  the  woman  was  entirely  recovered. 
Mr.  John  Camden,  of  New  Orleans,  and  Peter  G.  Camden,  form- 
erly a  Mayor  of  this  city  (Saint  Louis),  will  both  testify  to  the 
correctness  of  this  statement. 

m 


EPHRAiM  McDowell 

In  1809  Mrs.  Jane  Crawford,  who  had  ovarian  disease,  called 
upon  James  McDowell,  who  graduated  at  the  university  of 
Pennsylvania,  in  1806,  and  who  was  then  commencing  the  prac- 
tice of  medicine  and  surgery  in  Danville,  Ky.,  Dr.  E.  McDowell 
having  retired  to  the  country.  On  consultation  with  Dr. 
Ephraim  McDowell,  it  was  determined  to  operate,  and  in  the 
presence  of  David  Cowan,  Benjamin  Perkins,  and  others.  Dr. 
James  McDowell  performed  the  operation  with  the  assistance 
of  Dr.  E.  McDowell.  Learning  the  facts  as  stated  by  Cowan 
and  Perkins,  I  wrote  to  Mrs.  Jane  Crawford,  whose  answer  is 
now  in  my  possession  and  is  as  follows: 

Bloomington,  Indiana, 

August,  1824. 

I  received  your  letter  asking  me  who  performed  the  opera- 
tion for  ovarian  disease  on  me,  and  all  I  have  to  state  is  that 
Dr.  James  McDowell  did  the  cutting  and  the  dressing,  but 
Dr.  E.  McDowell  was  present  and  assisted  him. 

Dr.  James  McDowell  died  in  1812,  before  a  report  of  the 
case  was  made  by  Dr.  E.  McDowell,  in  the  Eclectic  Repertory 
of  Philadelphia.    Fiat  justitia  mat  ccelum. 

That  Dr.  E.  McDowell  has  performed  the  operation,  as  re- 
ported by  Doctors  Gross  and  Miller,  is  probably  very  true,  but 
while  he  claims  credit  for  himself,  he  should  do  justice  to  others. 

The  above  letter  of  Mrs.  Crawford  is  deserving  of  an 
explanation.    McDowell  in  his  card  of  1826  plainly  states: 

The  day  having  arrived,  and  the  patient  being  on  the  table, 
I  marked  with  a  pen  the  course  of  the  incision  to  be  made; 
desiring  him  to  make  the  external  opening,  which,  in  part,  he 
did;  I  then  took  the  knife  and  completed  the  operation,  as 
stated  in  the  Medical  Repertory. 

This  was  his  course  of  procedure,  not  only  in  this 
case,  but  also  in  several  others,  and  possibly  in  all  of  his 
cases.  Other  partners  and  assistants,  who  succeeded 
James  McDowell,  assumed  precisely  the  same  role,  and 
even  referred  to  this  role  as  "  a  sort  of  an  amanuensis." 

Under  the  stress  of  the  ordeal  it  would  be  quite  natural 

136 


ATTEMPTS  TO  DEPRIVE  HIM  OF  HIS  HONORS 

for  Mrs.  Crawford  to  become  confused,  or  even  not 
definitely  to  know  the  exact  relative  importance  of  the 
duties  of  the  uncle  and  the  nephew  on  that  occasion, 
much  less  to  define  them  clearly  in  a  letter  written 
years  thereafter. 

But  this  letter  and  the  foregoing  statement  by  Dr. 
J.  N.  McDowell  shed  a  definite  light  that  almost  certainly 
explains  the  phrase,  "In  five  days  I  visited  her,"  etc., 
which  has  formed  the  basis  for  so  much  sarcasm.  At  the 
time  of  the  Crawford  case  McDowell  refers  to  his  being 
in  delicate  health,  and  his  intention  to  remove  to  the 
country  in  the  spring.  The  account  of  Dr.  J.  N.  McDowell 
states  that  he  had  retired  to  the  country;  hence  we 
can  fairly  infer  that,  if  McDowell  had  not  actually 
removed  to  the  country,  he  at  least  periodically  retired 
there  for  rest,  and  during  his  absence  his  nephew  attended 
to  his  duties  and,  as  Mrs.  Crawford  says,  "did  the 
dressing."  In  five  days  he  returned  and  visited  her. 
This,  it  seems,  satisfactorily  disposes  of  the  much-dis- 
cussed phrase. 

As  a  biography  is  but  the  history  of  an  individual,  and 
as  an  incomplete  history  is  obviously  undesirable,  the 
additional  comment,  taken  from  the  biography  written 
by  the  granddaughter  of  McDowell,  Mary  Y.  Riden- 
baugh,  assists  one  in  understanding  the  criticisms  of 
his  nephew. 

Speaking  of  Dr.  J.  Nashe  McDowell,  the  Ridenbaugh 
sketch  is  as  follows: 

When  he  was  a  youth  much  of  his  time  was  spent  in  the 
family  of  his  uncle,  Dr.  Ephraim  McDowell,  and  it  was  there 
that  he  formed  an  ardent  attachment  for  his  cousin,  Mary 
McDowell,  whose  beauty  has  been  alluded  to. 

When  he  made  his  vows  expressing  more  than  cousinly 
affection,  for  her,  she,  with  a  sincerity  and  frankness  that 
characterized  a  genuine  noble-hearted  girl,  candidly  told  him 

137 


EPHRAiM  McDowell 

that  she  could  only  regard  him  in  the  light  of  a  relative,  never 
in  that  of  love,  desiring  him  earnestly  to  banish  from  his  mind 
such  a  thought  as  making  her  his  wife. 

She  confided  to  her  father,  as  became  a  daughter,  what  she 
had  heard  from  her  cousin.  Doctor  McDowell  immediately 
sought  his  nephew,  and  with  kind,  but  decisive  manner  empha- 
sized her  decision  and  request.  The  nephew  became  angry  and 
reflected  on  his  uncle,  charging  him  with  influencing  his  daughter 
against  him,  an  inference  in  which  he  undoubtedly  was  mistaken. 

From  that  time  a  coolness  existed  between  the  two,  the 
nephew  leaving  his  uncle's  house  and  never  returning,  nor  did 
he  ever  forgive  him.  He  sought  new  fields  of  friendship,  and  in 
course  of  time  a  new  field  of  love.  The  two  never  met  again. 
The  younger  carried  with  him  to  the  grave  his  feeling  of  hatred 
toward  the  elder,  and  would  never  listen  to  any  eulogy  bestowed 
on  him  for  his  grand  surgical  achievements. 

In  all  of  this  McDowell  seems  to  have  been  the  victim 
of  his  own  modesty  and  magnanimity;  he  was  always 
ready  to  share  with  others  a  division  of  the  credit,  that 
was  out  of  reason,  and  distinctly  detrimental  to  his  own 
honors.  His  nephew,  James  McDowell,  may  not  have 
taken  advantage  of  this  characteristic,  but  it  is  evident 
that  others  did. 

The  criticisms  of  Dr.  James  Johnson,  while  vicious, 
stubborn,  and  mistaken  in  their  nature,  were  after  all 
expressions  that  had  the  ring  of  sincerity.  He  bluntly 
expressed  his  convictions,  although  mistaken  as  they 
were,  without  hardly  any  reservation.  We  are  scarcely 
able,  however,  to  entertain  quite  the  same  feeling 
towards  other  and  later  criticisms,  especially .  those 
of  Sir  Spencer  Wells  and  Mr.  Lawson  Tait.  With 
all  deference  to  Sir  Spencer,  we  cannot  escape  the  conclu- 
sion, that  a  criticism  like  the  following  is  neither  fair  to 
McDowell  nor  entirely  creditable  to  the  critic. 

No  one  can  dispute  the  validity  of  the  direct  claim  of  Mc- 
Dowell as  designedly  the  first  rational  ovariotomist.     At  the 

136 


COMMENTS  OF  SIR  T.  SPENCER  WELLS 

same  time  it  must  be  maintained  that  still  greater  merit  of 
pointing  out  the  absence  of  any  physiological  reasons  against 
the  operation,  the  possibility  of  its  safe  performance  in  the 
human  female,  and  the  class  of  cases  in  which  it  ought  to  be 
admissible,  is  due  to  a  series  of  eminent  British  surgeons.  But 
in  this  country  such  is  the  sacredness  of  human  life,  even  when 
threatened  by  fatal  diseases — so  strong  is  the  consciousness  that 
the  introduction  of  innovations,  like  ovariotomy,  insures  the 
destruction  or  shortening  of  a  certain  number  of  lives  during 
the  tentative  stage  of  the  practice — that  men,  even  of  the  stamp 
of  the  Hunters  and  the  Bells,  naturally  shrank  from  the  respon- 
sibility imposed  upon  them  by  their  position  and  reputation  of 
adopting  it  as  a  part  of  legitimate  surgery. 

"No  one  can  dispute  the  validity  of  the  direct  claim  of 
McDowell  as  designedly  the  first  rational  ovariotomist." 
Here  is  where  Sir  Spencer  might  have  stopped,  but  un- 
fortunately he  proceeds,  and  in  so  doing,  he  endeavors  to 
take  back,  in  part  at  least,  with  one  hand,  that  which  he 
has  already  freely  given  with  the  other. 

What  justification  could  there  be  for  him  to  obscure 
McDowell's  honors  by  endeavoring  to  divert  a  part  of 
the  credit  to  "a  series  of  eminent  British  surgeons?" 
Let  us  continue  the  analysis  of  the  above  extract. 

At  the  same  time  it  must  be  maintained,  that  still  greater 
merit  of  pointing  out  the  absence  of  any  physiological  reasons 
against  the  operation,  the  possibility  of  its  safe  performance  in 
the  human  female,  and  the  class  of  cases  in  which  it  ought  to 
be  admissible,  is  due  to  a  series  of  eminent  British  surgeons. 

Replying  to  this  quotation,  we  say  that  we  are  un- 
able to  see  how  it  is  possible  to  balance  an  academic 
statement,  however  clear  and  convincing  it  may  be, 
against  several  successfully  accomplished  acts. 

The  Hunters,  whom  Wells  doubtless  had  in  mind,  and 
whose  views  he  quoted,  added  nothing  original  to  the 
status  of  the  question.     The  most  that  can  be  said  for 

139 


EPHRAiM  McDowell 

them  is  that  they  added  the  weight  of  their  authority 
to  the  views  that  had  been  expressed  long  before  the 
time  of  the  Hunters  and  not  by  British  surgeons. 

In  the  case  of  WiUiam  Hunter,  this  support,  although 
questionable  in  its  importance,  was  added  not  without 
reservation;  his  brother  John,  twenty-eight  years  there- 
after, spoke  with  more  freedom,  but  even  he  qualified  his 
statement  by  saying,  "when  the  disease  can  be  ascer- 
tained in  an  early  stage." 

The  real  facts,  as  we  will  endeavor  later  on  to  prove, 
are  that  William  Hunter  was  very  pessimistic  and  hopeless 
in  his  forecast;  that  this  pessimism  was  not  without  its 
influence,  is  proved  by  subsequent  events;  that  even 
after  McDowell  had  five  times  demonstrated  the  error  of 
William  Hunter's  pessimism,  no  attempt  in  the  direction 
of  ovariotomy  was  made  until  October,  1823;  and  that 
this  attempt  was  by  Lizars,  in  Scotland,  and  proved  to 
be  a  mistaken  diagnosis.  This  was  fourteen  years  after 
McDowell's  first  case. 

May  we  not,  therefore,  ask  to  which  British  surgeons 
does  Wells  refer?  The  particular  quotations  from  William 
and  John  Hunter  which  Wells  employed  to  support  his 
contention  are: 

Dr.  William  Hunter,  in  a  paper  "On  Cellular  Tissue,"  in  the 
second  volume  of  the  "Medical  Observations  and  Inquiries," 
after  stating  that  the  trocar  is  almost  the  only  palliation  in  the 
treatment  of  ovarian  dropsy,  says,  "It  has  been  proposed  by 
modern  surgeons,  deservedly  of  the  first  reputation,  to  attempt 
a  radical  cure  by  incision  and  suppuration  or  by  the  excision  of 
the  cyst."  Hunter  says,  "If  it  be  proposed  indeed  to  make 
such  a  wound  in  the  belly  as  will  admit  two  fingers  or  so,  and  then 
tap  the  bag  and  draw  it  out  so  as  to  bring  its  root  or  peduncle 
close  to  the  wound  of  the  belly,  that  the  surgeon  may  cut  it 
without  introducing  his  hand,  surely  in  a  case  otherwise  so 
desperate,  it  might  be  advisable  to  do  it  could  we  beforehand 
know  that  the  circumstances  would   admit  such   treatment." 

140 


COMMENTS  OF  SIR  T.  SPENCER  WELLS 

In  a  lecture  delivered  in  1785  John  Hunter  says: 

I  cannot  see  any  reason  why,  when  the  disease  can  be  ascer- 
tained in  an  early  stage,  we  should  not  make  an  opening  into 
the  abdomen  and  extract  the  cyst  itself.  Why  should  not  a 
woman  suffer  spaying,  without  danger  as  well  as  other  animals 
do?  The  merely  making  an  opening  into  the  abdomen  is  not 
highly  dangerous.  In  a  sound  constitution  perhaps  a  wound 
merely  into  the  abdomen  would  never  be  followed  by  death  in 
consequence  of  it. 

Anent  these  quotations,  it  may  be  said  that  the  first 
is  hardly  a  fair  index  of  William  Hunter's  views,  an 
opinion  the  accuracy  of  which  can  easily  be  determined  by 
a  study  of  Section  IX  of  his  paper,  from  which,  for 
present  purposes,  but  one  paragraph  is  added  as  a  parallel. 

If  I  may  form  a  judgment  from  what  I  have  seen  both  in 
the  living  and  in  the  dead  body,  I  should  believe  that  the  dropsy 
of  the  ovarium  is  an  incurable  disease,  and  that  a  patient  will 
have  the  best  chance  of  living  longest  under  it  who  does  the  least 
to  get  rid  of  it.    The  trocar  is  almost  the  only  palliative. 

In  support  of  the  view  that  the  Hunters  added  nothing 
original,  and  to  illustrate  the  early  evolution  of  the  idea, 
a  review  of  some  of  the  first  references  is  in  order. 

It  is  an  historical  fact  that  certain  kings  of  Lydia  caused  the 
ovaries  of  women  to  be  removed,  using  them  sometimes  in  their 
service  and  sometimes  for  their  pleasure.  Andramystes  is  said 
by  Anthenaeus  to  have  been  the  first  who  did  this;  and  that  he 
placed  the  women  at  service  instead  of  eunuchs;  while  Gyges 
hoped  by  this  operation  to  bestow  upon  them  perpetual  youth. 
Ancient  authors,  however,  disagree  as  to  the  precise  character 
of  the  operation.  For,  while  Strabo  and  Diemerbroech  assert 
that  the  ovaries  were  actually  extirpated,  Adolphus  states  that 
the  uterus  was  removed;  and  others  still  that  only  circumcision 
(probably  clitoridectomy)  was  performed.    {Peaslee.) 

We  pass  on  to  several  writers  of  the  seventeenth  and  eigh- 
teenth centuries,  as  Vierus,  Riolan  ("Opera  prima,"  Paris,  1610; 

141 


EPHRAiM  McDowell 

"Anatome,"  p.  142);  Diemerbroeck  ("Anatomia  corporis 
humani,"  Lyon,  1679;  I,  I,  c.  xxiii);  Boerhave  "Prselect,  Academ. 
in  prop,  inst.,"  f.  5,  pars  2  and  669);  Graaf  ("De  Mulierum 
Organ,  General,  inserv.  Tract,  nov."  cap.  13);  Plater  ("Observ. 
libri.  tres,"  Basle,  1680,  p.  248),  etc.,  who  either  mention  the 
extirpation  of  the  ovaries  as  having  been  performed,  or  propose 
this  operation  in  the  treatment  of  nymphomania.     {Wells.) 

Justus  Theodor  Schorkoff,  in  his  "Dissertatio  medica 
inauguralis  de  Hydrope  Ovarii,"  February  13,  1685,  expresses 
the  belief  that  the  extirpation  of  dropsical  ovaries  would  lead 
to  a  permanent  cure,  if  the  operation  was  less  cruel  and  hazardous. 

Ehrenfried  Schlenker,  in  the  21st  thesis  of  his  dissertation 
"De  singulari  ovarii  sinistri  morbo,"  Leid,  October  30,  1722, 
proposes  the  question  whether  a  radical  cure  of  diseased  ovaries 
may  not  be  effected  by  the  removal  of  the  organ  through  an 
incision  in  the  abdomen,  but  leaves  the  answer  to  his  more 
experienced  colleagues. 

Soon  after  Schlenker,  Willius,  of  Basle,  published  (in 
173 1)  a  pamphlet,  "Specimen  medicum  sistens  stupendum 
abdominis  tumorem,"  which  contains  the  following  pass- 
ages: "When,  however,  the  dropsy  fills  all  the  chambers 
of  the  ovary,  when  the  fluid  is  thick  and  viscid,  and  no 
hope  of  recovery  is  entertained,  we  question  whether  such 
an  ovary  ought  not  to  be  extirpated,  and  so  the  root  and 
cause  of  the  disease  be  removed. 

Giovanni  Targioni  Tozetti,  recommends  the  extirpa- 
tion of  the  ovaries  as  a  last  resource,  when  all  other 
curative  means  have  failed."  ("Prima  raccolta  di  osser- 
vazioni  mediche,"  Firenze,  1752,  p.  78.) 

Regarding  the  statement : 

But  in  this  country  such  is  the  sacredness  of  human  life, 
even  when  threatened  by  fatal  disease;  so  strong  is  consciousness 
that  the  introduction  of  innovations,  like  ovariotomy,  insures 
the  destruction  or  shortening  of  a  certain  number  of  lives  during 
the  tentative  stage  of  the  practice,  that  men,  even  of  the  stamp 

142 


COMMENTS  OF  SIR  T.  SPENCER  WELLS 

of  the  Hunters  and  the  Bells,  naturally  shrank  from  the  respon- 
sibility imposed  upon  them  by  their  position  and  reputation  of 
adopting  it  as  a  part  of  legitimate  surgery. 

We  insist  that  no  more  sacredness  surrounded  human 
Hfe  in  Great  Britain  than  it  did  in  the  wilds  of  Kentucky; 
but  what  did  exist  in  the  wilds  of  Kentucky  was  a  freedom 
of  action,  the  equal  of  which  was  perhaps  never  before 
known  in  any  other  enlightened  state  or  country.  This 
freedom  of  action  is  precisely  what  did  not  exist  in 
Great  Britain,  and  upon  the  keen  appreciation  of  this 
fact  is  based  the  statement  that  if  McDowell  had  lived 
under  the  shadow  of  a  great  university  like  that  of 
Edinburgh,  he  would  not  have  become  the  first  ovario- 
tomist.  His  whole  initiative  would  have  been  smothered 
in  the  overpowering  conservatism  of  this  environment. 

If  human  experience  has  taught  us  anything,  it  is 
that  suffering  and  danger  make  kindred  of  us  all.  Danville 
and  its  vicinity  in  1809,  represented  the  frontier  of  the 
United  States,  and  it  is  absurd  to  speak  of  the  "sacredness 
of  human  life"  in  as  old  and  settled  a  country  as  Great 
Britain,  in  comparison  with  the  sacredness  of  life  as  it 
existed  in  Kentucky,  then  situated,  as  she  was,  on  the 
outer  fringe  of  civilization.  In  fact,  the  sacredness  of  life 
in  Kentucky,  and  the  hospitality  which  is  so  inseparable 
from  this  sacredness,  were  at  such  a  high  tide,  that  this 
state  became  noted  for  possessing  to  an  extreme  degree 
these  two  qualities. 

In  preparing  this  work,  we  have  purposely  preceded 
the  study  of  McDowell's  life  with  a  brief  description  of 
the  conditions  and  the  people  that  existed  contemporane- 
ous with  the  first  ovariotomy;  and  we  emphatically  reiter- 
ate that  unless  the  reader  acquires  a  good  mental  grip 
upon  the  conditions  and  the  people  as  they  then  existed, 
he  will  sim.ply  fail  in  securing  a  clear  conception  of  the 

143 


EPHRAiM  McDowell 

conditions  that  made  the  first  ovariotomy  possible,  and 
of  the  environment  in  which  it  was  performed. 

To  the  repeatedly  expressed  belief  that  if  McDowell 
had  practiced  in  Edinburgh,  it  is  more  than  likely  that 
he  would  never  have  been  the  first  ovariotomist,  we  may 
add  that  if  he  were  Hving  in  Kentucky  to-day,  and  should 
attempt  the  same  step  or  something  of  similar  magni- 
tude, for  the  first  time,  it  is  not  unlikely  that  a  deterring 
hand  would  be  placed  upon  his  shoulder.  This  condition 
is  due  to  the  growing  centralization  of  power,  which  is 
such  a  dominant  feature  of  the  present  day,  and  to  the 
attending  inclination  to  regulation,  which  at  times  be- 
comes meddlesome,  and  which  is  extending  from  indi- 
vidual to  individual,  and  from  nation  to  nation,  until  it 
has  reached  such  a  degree  as  to  threaten  not  only  the  free 
development  of  individuals,  but  of  nations  as  well.  The 
continuation  of  such  a  drift  leads  either  to  the  collapse 
of  this  extreme  tendency,  or  to  a  period  of  human  deca- 
dence, for,  after  all,  the  progress  of  the  world  is  depend- 
ent first  upon  individual  effort,  just  as  the  first  ovari- 
otomy was. 

Sir  Spencer  Wells  must  have  known  all  this,  for  he 
speaks  of  the  advantages  which  McDowell  possessed  by 
being  unhampered  in  a  free  country. 

The  story  of  the  first  ovariotomy,  expressed  in  a  few 
words,  is  that,  after  a  varied  experience  covering  a  period 
of  fourteen  years,  during  which  he  learned  to  rely  upon 
his  own  common  sense  and  courage,  in  addition  to  his 
knowledge  of  anatomy  and  the  principles  of  surgery, 
McDowell  was  confronted  by  an  ovarian  tumor,  not  in 
its  early  stage,  but  in  the  latter  stage  of  its  development. 
Instead  of  dodging  the  issue,  after  a  prolonged  dis- 
cussion, and  an  exhibition  of  the  case,  as  had  been  the 
custom  in  metropolitan    centers  up  to  that  date,  and 

144 


COMMENTS  OF  SIR  T.  SPENCER  WELLS 

even  for  some  time  thereafter,  this  country  doctor,  who 
through  self-reHance  had  grown  accustomed  to  meet 
surgical  difficulties  fully  and  fairly,  began  at  once  to  plan 
the  operation. 

As  it  has  been  said,  with  his  "mother  wit"  and  his 
courage,  freed  from  the  restraining  influence  of  others, 
he,  singly  and  alone,  successfully  solved  the  problem  of 
ovarian  tumors.  The  operation  which  he  performed  has 
in  its  basic  features  remained  as  he  gave  it  to  us;  and  aside 
from  the  refinements  incident  to  surgery  in  common,  will 
remain  so  until  the  end  of  time.  Therefore,  in  view  of 
its  unbounded  importance,  it  is  time  that  all  references 
to  his  claims  should  be  absolutely  free  from  all  possi- 
ble equivocation. 


10  145 


CHAPTER  VIII 

"a  dropsy  of  the  left  ovary  cured,"  by  ROBERT  HOUSTOUN 

THE      COMMENTS     OF     MR.      LAWSON     TAIT ^ANALYSIS     OF 

HOUSTOUN's  claims  by  MR.  J.  GRIEG  SMITH — ^McDOWELL's 
SUPPOSED  PREDECESSORS EARLY  PROGRESS  OF  OVARI- 
OTOMY  CHRYSMAR's  CASES. 

Through  the  American  ovariotomist,  Dr.  Washington 
L.  Atlee,  the  case  of  Robert  Houstoun  was  brought  to 
pubHc  notice,  and  became  the  basis  of  controversial 
writings,  on  this  as  well  as  on  the  other  side  of  the  Atlantic, 
as  to  the  priority  of  the  first  ovariotomist. 

Calmly  considered,  the  whole  controversy  swings  upon 
the  use  of  the  word  ovariotomy,  which  literally  means 
the  cutting  into,  but  not  the  removal  of  an  ovarian  tumor. 
Houstoun  did  cut  into  an  ovarian  tumor  a  century 
before  McDowell.  This,  literally  speaking,  more  nearly 
constituted  an  ovariotomy.  To  be  exact,  however,  Hous- 
toun's  case,  as  well  as  McDowell's,  was  not  an  ovariotomy, 
but  an  ovariostomy,  i.e.,  an  incision  into  an  ovarian  cyst 
for  drainage,  whereas  McDowell  removed  the  ovarian 
tumor  in  toto,  which,  literally  speaking,  constituted 
an  ovariectomy. 

That  an  error  of  expression  Involving  alike  Houstoun 
and  McDowell,  should  become  the  basis  of  a  discussion, 
or  that  it  should  really  lead  to  any  confusion  among 
intelligent  medical  men  is  ludicrous.  To  pretend  that 
there  Is  any  reason  for  a  misunderstanding  upon  this 
subject  Is  like  judging  the  works  of  Shakespeare  or  Darwin 
by  any  grammatical  peculiarities  that  may  be  found 
therein.  Men  Hke  Atlee,  Wells,  and  Talt,  who  dwelt  upon 
Houstoun's  claims,  did  not  acquire  their  fame  and  fortune 
by  practicing  Houstoun's  operation,  although  it  was  more 

146 


DROPSY  OF  OVARY  CURED  BY  ROBERT  HOUSTOUN 

nearly  an  ovariotomy  in  a  literal  sense.  They  acquired 
their  fame  and  fortune  by  following  McDowell's  opera- 
tion, which  was  an  ovariotomy  in  the  usual  sense,  but  an 
ovariectomy  in  the  literal  sense.  It  was  not  Houstoun 
who  first  solved  the  question  of  dealing  with  ovarian 
tumors,  and  that  is  what  we  have  in  mind  when  we  think 
of  ovariotomy.  We  are  not  interested  in  the  errors  of 
surgical  terminology  to  such  a  degree  as  to  allow  ourselves 
to  overlook  the  very  important  and  vital  fact  as  to  who 
it  was  that  rescued  humanity  from  protracted  suffering 
and  premature  deaths,  and  who,  through  his  achievement 
several  times  repeated,  gave  us  the  basis  on  which  abdom- 
inal surgery  is  founded,  and  ovarian  tumors  are  removed. 

Nor  was  Houstoun  the  first  to  open  the  peritoneal 
cavity  for  an  intra-peritoneal  procedure.  His  operation, 
for  that  time,  was  a  bold  and  creditable  step,  but  it  was 
barren  of  any  influence  upon  the  development  of  ovari- 
otomy as  it  was  practiced  by  McDowell. 

Since  the  case  has  acquired  such  a  distinct  historic 
interest,  we  reproduce  Houstoun's  own  report  of  the 
operation  as  published  in  "The  Philosophical  Transac- 
tions", No.  381,  Jan.,  etc.,  1724,  p.  8  (from  the  year  1720 
to  the  year  1832),  abridged  and  Disposed  under  General 
Heads,  vol.  vi,  parts  ii,  iii,  iv,  that  the  reader  may  reach 
his  own  conclusions. 

A  Dropsy  in  the  Left  Ovary  of  a  Woman  Aged  Fifty-eight 
Years  Cured  by  a  Large  Incision  Made  in  the  Left  Side  of 
the  Abdomen,  by  Dr.  Robert  Houstoun. 

In  August,  1701,  Margaret  Miller,  living  not  far  from  Glas- 
gow, informed  me  that  her  midwife  in  her  last  lying-in,  at  forty- 
five  years  old,  having  violently  pulled  away  the  burthen,  she 
was  so  very  sensibly  affected  by  the  pain,  which  then  seized 
her  in  the  left  side,  between  the  umbilicus  and  groin,  that  she 
scarce  had  ever  been  free  from  it  after,  that  it  had  troubled 
her  more  or  less  during  thirteen  years  together;  that  for  two 

147 


EPHRAiM  McDowell 

years  past  she  had  been  extremely  uneasy,  her  belly  grew  very 
large,  and  a  difficulty  of  breathing  increased  continually  upon 
her;  insomuch  that  for  the  last  six  months  she  could  scarce 
breathe  at  all  without  the  utmost  difficulty.  That  in  all  that 
space  of  time  she  had  scarcely  eaten  so  much  as  would  nourish  a 
suckling  child,  having  quite  lost  her  appetite,  and  that  for  the 
last  three  months  she  had  been  forced  to  lie  constantly  on  her 
back,  not  daring  to  move  at  all  to  one  side  or  other.  This 
tumor  drew  towards  a  point,  and  was  grown  to  so  monstrous 
a  bulk  that  it  engrossed  the  whole  left  side  from  the  umbilicus 
to  the  pubes,  and  stretched  the  abdominal  muscles  to  so  unequal 
a  degree  that  I  never  saw  the  like.  Her  lying  so  continually  on 
her  back,  having  previously  excoriated  her,  added  much  to  her 
sufferings,  which,  with  the  want  of  rest  and  appetite,  had  wasted 
her  to  skin  and  bone.  I  told  her  that  in  order  effectually  to 
relieve  her,  and  remove  the  cause  of  the  swelling,  I  must  lay 
open  a  great  part  of  her  belly,  but  feared  she  would  not  be  able 
to  undergo  such  an  operation;  she  seemed  not  at  all  frightened, 
but  heard  me  without  disorder,  and,  though  scarcely  able  to 
speak,  urged  me  to  perform  it.  I  must  confess  I  drew  almost 
all  my  confidence  from  her  unexpected  resolution,  and  without 
loss  of  time  prepared  what  the  place  would  allow,  and  with  an 
imposthume  lancet  laid  open  about  an  inch;  but  finding  nothing 
issue,  I  enlarged  it  two  inches,  and  even  then  nothing  came 
forth,  but  a  little,  thin,  yellowish  serum;  so  I  ventured  to  lay 
it  open  about  two  inches  more;  I  was  not  a  little  startled  to  find 
only  a  glutinous  substance  stop  up  so  large  an  aperture;  but  my 
great  difficulty  was  to  remove  it;  I  tried  my  probe,  I  endeavored 
to  do  it  with  my  finger,  but  all  in  vain;  it  was  so  slippery  that 
it  eluded  every  touch  and  the  strongest  probe  I  could  take. 
I  wanted  in  this  place  almost  everything  necessary,  but  be- 
thought myself  of  a  very  odd  instrument,  yet  as  good  as  the 
best,  because  it  answered  the  end.  I  took  a  strong  fir  splinter, 
and  having  wrapped  some  lint  about  it,  I  thrust  it  into  the 
wound,  and  by  turning  and  winding  it  drew  out  above  two  yards 
length  of  a  substance  thicker  than  any  jelly,  or  rather  like  glue 
that  was  fresh  made  and  hung  out  to  dry;  the  breadth  of  it  was 
about  ten  inches;  this  was  followed  by  nine  full  quarts  of  such 
matter  as  I  have  met  in  steatomatous  and  atheromatous  tumors, 
with  several  hydatides  of  various  sizes  containing  a  yellowish 

148 


DROPSY  OF  OVARY  CURED  BY  ROBERT  HOUSTOUN 

serum,  the  least  of  them  bigger  than  an  orange,  with  several 
large  pieces  of  membranes,  which  seemed  to  be  parts  of  the  dis- 
tended ovaries.  Having  squeezed  out  all  I  could,  I  stitched  up 
the  wound  in  three  places,  almost  equidistant,  and,  having  no 
other  but  Lucatellus  balsam,  with  it  I  covered  a  pledget,  the 
whole  length  of  the  wound,  and  over  that  laid  several  compresses 
dip't  in  warm,  French  brandy;  and  because  I  judged  that  the 
parts  might  have  lost  their  spring  by  so  vast  and  so  long  a  dis- 
tention, I  dip't  in  the  same  brandy  a  large  napkin  four  times 
folded  and  applied  it  all  over  the  dressing  and  with  a  couple 
of  strong  towels,  which  were  also  dip't,  I  swathed  her  round  the 
body,  and  then  gave  her  about  four  ounces  of  this  mixture: 

R. — ^Aq.  menthae lb.  ss. 

Aq.  cinnamomi  fort lb.  iss. 

Syr.  diacodii oz.  vii — M. 

ordering  her  also  to  take  two  or  three  spoonfuls  of  it  four  times 
a  day.  The  cinnamon  water  was  drawn  off  from  canary  and  the 
best  cinnamon.  Next  morning  I  found  her  in  a  bathing  sweat, 
and  she  informed  me  with  great  joy  that  she  had  not  slept  so 
much  nor  found  herself  so  well  refreshed  at  any  time  for  three 
months  past.  I  carefully  dressed  her  wound  in  the  same  manner 
as  above,  once  a  day,  for  about  a  week;  I  kept  in  the  lower  part 
of  the  wound  a  small  tent,  which  discharged  some  seriosities  at 
every  dressing  for  four  or  five  days.  But,  business  calling  me 
elsewhere  I  instructed  her  daughters  how  to  dress  the  wound, 
and  told  them  what  diet  I  thought  most  proper,  which  was 
chiefly  strong  broths  made  of  an  old  cock,  in  each  porringer 
whereof  was  one  spoonful  of  cinnamon  water;  this  she  repeated 
four  times  a  day,  and  it  gave  her  new  life  and  spirits.  After 
three  weeks  absence  I  called  at  her  house,  and  finding  it  shut 
up  was  a  little  surprised,  but  had  not  gone  far  before  I  was 
much  more  so,  for  I  found  her  sitting  wrapt  up  in  blankets  and 
giving  directions  to  some  laborers  who  were  cutting  down  her 
corn.  She  mended  apace  and  lived  in  perfect  health  from  that 
time  till  October,  1714,  when  she  died  after  ten  days'  sickness. 

The  comment  of  Sir  Spencer  Wells  upon  Houstoun's 
operation  is: 

Although  this  isolated  case  of  Doctor  Houstoun  undoubtedly 
strengthens  the  claim  of  British  surgery  to  the  honor  of  originally 

149 


EPHRAiM  McDowell 

practicing  ovariotomy,  it  will  hardly  deprive  Doctor  McDowell 
of  his  undeniable  merit  of  having  been  the  first,  who,  guided  by 
scientific  principles,  enriched  modern  surgery  with  the  operation. 

The  expressions  of  Mr.  Lawson  Tait  upon  Houstoun's 
case  are  so  unusual  and  so  dogmatic  as  to  deserve  repetition : 

There  can  be  no  question  from  Houstoun's  description  that 
he  had  diagnosed  a  dropsy  of  the  ovary  and  that  he  had  to  deal 
with  a  condition  which  is  often  one  of  the  most  difficult  that 
can  be  met  with  in  the  performance  of  ovariotomy,  and  he 
completed  his  operation  hy  removing  the  cyst.  Although  he  does 
not  describe  his  division  of  the  pedicle,  or  his  having  tied  it,  it  is 
almost  certain  that  he  did  both.  He  certainly  must  have  seen  and 
divided  the  pedicle,  for  he  describes  the  disease  as  being  of  the 
left  ovary;  therefore  he  saw  the  pedicle.  Perhaps  he  tore  it 
and  it  did  not  need  tying.  That  he  performed  a  complete  ovari- 
otomy is  certain,  from  his  having  noticed  secondary  cysts  as 
well  as  from  the  recovery  of  his  patient  and  the  fact  that  she 
lived  for  thirteen  years  afterward,  in  perfect  health. 

In  conveying  such  views  it  is  to  be  regretted  that  Mr. 
Tait  failed  to  add  the  reasons  why  he  reserved  the  right 
to  construe  Houstoun's  description  to  suit  his  own  point 
of  view  and  convenience.  We  fully  agree  with  Grieg 
Smith  when  he  says,  "The  description  of  the  operation  is 
clear  and  definite  enough,  nor  is  it  lacking  in  detail;"  and 
further,  "What  right  have  we  to  infer  that  he  did  more 
than  he  simply  states?" 

Mr.  Tait  is  so  evidently  biased  that  he  seems  unable 
to  reach  a  conclusion  even  as  to  McDowell's  nationality. 
He  cannot  determine  with  any  degree  of  certainty  whether 
McDowell  was  a  Scotchman  or  an  American.  He  says: 
"It  is  to  a  young  Scotchman,  who  was  a  pupil  of  John 
Bell's  in  1793,  that  we  owe  the  revival  of  the  operation 
and  its  performance  upon  a  scale  which  amounted  to 
that  of  a  legitimate  experiment;"  and  in  a  footnote  adds: 
"My  American  reader  may  object  that  McDowell  was 

150 


DROPSY  OF  OVARY  CURED  BY  ROBERT  HOUSTOUN 

not  born  in  Scotland.  Of  this,  however,  we  are  not 
yet  clear.  At  any  rate,  his  father  and  mother  were 
Scotch  and  at  the  time  of  his  birth,  1771,  the  States  did 
not  exist." 

It  is  true  the  States  did  not  exist  in  1771,  but  the 
American  Colonies  did,  and  furthermore  the  McDowell 
family  played  important  roles  in  transforming  these 
American  Colonies  into  the  United  States.  Moreover 
when  the  operation  was  performed  in  1809,  they  not 
only  existed,  but  it  was  performed  in  the  State  ad- 
joining the  one  in  which  McDowell  was  born,  and  which, 
at  the  time  of  his  birth,  was  still  an  integral  part  of  his 
native  state,  Virginia.  Furthermore,  to  remove  any  doubt 
that  Mr.  Tait's  statement  may  have  created,  permit  us 
to  say  definitely  that  not  only  was  Ephraim  McDowell 
born  on  this  side  of  the  Atlantic  and  in  Virginia,  but  also 
was  his  father  born  on  this  side  of  the  Atlantic,  but  in 
Pennsylvania.  As  for  his  mother,  who  was  Miss  Mary 
McClung,  she  was  born  in  Ireland,  of  Scotch  parentage. 

In  fact,  the  very  idea  of  McDowell  seems  so  repug- 
nant to  Mr.  Tait  that  he  not  only  refuses  to  consider 
him  as  the  first  ovariotomist,  but  in  an  earlier  edition 
of  his  work  pubHshed  in  1879,  he  fails  even  to  mention 
his  name  in  connection  with  the  operation. 

No,  with  all  deference  to  these  distinguished  gentle- 
men, after  a  careful  consideration  of  the  entire  subject, 
we  are  unwilling  to  divert  any  part  of  the  hard-earned 
and  justly  deserved  honors  of  this  country  doctor  to  "a 
series  of  eminent  British  surgeons."  Not  even  to  John 
Bell,  with  all  the  admiration  in  which  we  hold  him,  and 
the  esteem  in  which  McDowell  muist  have  held  him,  as 
is  evidenced  by  his  sending  a  copy  of  his  report  to  Bell  at 
the  same  time  that  he  sent  a  copy  to  Physick. 

McDowell  attended  lectures  in  Scotland,  upon  medi- 

151 


EPHRAiM  McDowell 

cine  and  surgery,  that  included  diseases  of  the  ovaries. 
But  what  was  at  that  time  said  upon  this  subject  did  not 
originate  in  Great  Britain,  and,  from  all  indications,  made 
no  more  of  an  impression  upon  him  than  did  other  sub- 
jects that  came  up  during  his  attendance  at  the  University. 

Ovarian  tumors,  and  the  proper  measures  for  their 
relief,  were  the  subject  of  innumerable  debates  for  con- 
siderably more  than  a  century  before  McDowell's  time 
and  for  fully  a  half  i.  century  after  it.  The  discussions 
upon  this  subject  were  carried  on  to  a  far  greater  degree 
than  the  few  references  that  we  have  recorded  would 
ordinarily  lead  one  to  believe.  It  is  unfortunate  that 
these  discussions,  which  must  have  occurred  in  various 
countries  upon  this  subject  during  the  many  decades 
preceding  McDowell's  achievement,  and  which  are  repre- 
sented only  in  a  small  degree  in  recorded  literature,  should 
now  be  lost  to  us. 

Ovarian  tumors  existed  during  those  times  in  about 
the  same  degree  of  frequency  as  they  do  to-day.  It  is 
inconceivable,  therefore,  that  these  tumors  should  have 
failed  to  arouse  and  maintain  an  active  discussion  as  to 
their  possible  treatment  or  relief.  In  this  belief  the  Hmit- 
ed   instances  recorded  in  literature  amply  bear  us  out. 

Hence,  it  is  obvious  that  the  proposals  of  relief  were 
not  born  of  any  one  country  or  any  person,  but  were 
considered  in  many  countries  and  at  various  times.  These 
proposals  remained  in  an  academic  state,  until  they  were 
transferred  from  the  academic  realm,  in  which  McDowell 
found  them,  to  the  sphere  of  practical  usefulness,  in 
which  he    left  them,   and  in  which  they  will  continue. 

The  question  of  Robert  Houstoun  has  been  so  fully 
considered  by  J.  Grieg  Smith,  that  we  feel  justified  in 
adding  the  following  abstract  of  this  British  writer's  view 

upon  this  subject: 

152 


DROPSY  OF  OVARY  CURED  BY  ROBERT  HOUSTOUN 

Was  Robert  Houstoun,  of  Glasgow,  The  First  Ovarlotomist? 
By  J.  Grieg  Smith,  M.B.,  F.R.S.E.,  Surgeon  to  the  Royal 
Infirmary,  Bristol,  Professor  of  Surgery,  University  Col- 
lege, Bristol. 

Houstoun  was  certainly  not  the  first  to  suggest  operation 
in  extra-uterine  foetation.  The  operation  had  been  successfully 
performed  twenty  years  before  Houstoun  wrote.  Houstoun 
knew  it.  Curiously  enough,  the  proof  is  supplied  by  Houstoun 
himself  in  the  very  record  on  which  his  claims  to  be  the  father 
of  ovariotomy  are  founded. 

This  operation  of  successful  removal  of  an  extra-uterine 
foetus  by  Cyprianus  was  performed  on  December  17,  1694. 
Both  in  language  and  in  drawing  it  is  exceedingly  well  presented. 
The  operation  was  done  on  lines  which  would  be  followed  at  the 
present  day  by  Cyprianus — in  short,  shows  a  knowledge  of 
Anatomy  and  of  Pathology,  and  it  may  be  added  of  practical 
surgery  far  in  advance  of  anything  which  Houstoun  has  shown 
himself  possessed  of.  Now,  in  considering  Houstoun's  case  we 
must  be  certain  of  the  meaning  of  the  words  employed.  •  The 
case  undoubtedly  records  an  operation  of  ovariotomy  in  the 
literal  sense  of  the  term,  incision  of  an  ovary  or  an  ovarian 
growth.  What  is  claimed  for  him  is  that  he  performed  ovari- 
otomy in  the  usual  sense — ovariectomy  as  it  might  accurately 
be  called,  or  excision  of  an  ovary  or  ovarious  growth. 

For  this  last  operation  two  things  are  essential;  one,  that 
the  tumor  should  be  delivered  from  the  abdomen,  and  the  other, 
that  its  connection  with  the  body  should  be  severed.  It  is  un- 
necessary to  go  beyond  these  two  essentials;  and  there  is  not 
even  a  suggestion  that  either  was  carried  out. 

The  description  of  the  operation  is  clear  and  definite  enough, 
nor  is  it  lacking  in  detail.  There  is  no  difficulty  in  following  it. 
His  first  incision  enters  the  peritoneal  cavity  and  a  little  yellow 
serum  escapes;  his  next  incision  exposes  the  highly  collodial 
contents ;  at  the  third  the  contents  do  not  flow,  though  they  pro- 
trude; then  comes  the  fir  splinter,  which,  poked  about  inside, 
ruptures  a  secondary  cyst,  when  there  is  a  free  flow  of  fluid  and 
an  escape  of  secondary  cysts  with  "pieces  of  membranes." 

It  has  been  suggested  that  these  pieces  of  membranes  were  sac 
wall — the  true  tumor.  In  fact,  the  next  sentence  effectually  dis- 
poses of  this  idea,  for  it  runs:  Then  he  squeezed  out  all  he  could 

153 


EPHRAiM  McDowell 

and  "stitched  up  the  wound."  How  is  it  possible  to  squeeze  out 
contents  unless  the  sac  is  still  there?  And  is  it  conceivable  that 
a  man  who  could  so  minutely  describe  all  the  little  details  up 
to  the  point  of  squeezing  out  the  contents  could  forget  to  say 
a  word  about  the  delivery  of  what  was  evidently  a  large  poly- 
cystic growth,  and  also  the  severance  of  its  pedicle?  What 
right  have  we  to  infer  that  he  did  more  than  he  simply  states — 
namely,  that  after  squeezing  out  as  much  as  he  could  he  stitched 
up  the  wound?  I  submit  that  we  have  no  right  to  make  any 
larger  inference. 

There  is,  it  seems  to  me,  no  doubt  or  obscurity  about  the 
matter.  Houstoun  believed  with  his  compeers  that  ovarian 
dropsy  was  a  simple  dropsy  of  the  ovary,  and  was  to  be  treated 
by  tapping,  or,  if  there  v/ere  secondary  cysts  or  hydatides  by 
incision.  His  case  was  one  of  incision,  and  he  clearly  described 
it  as  such.  No  one  of  his  contemporaries  said  it  is  anything 
more  than  incision.  One  of  them,  indeed,  definitely  claims  it 
as  such,  and  uses  Its  success  as  an  argument  against  extirpation. 

Incising  such  a  growth  instead  of  tapping  it,  Houstoun  was 
well  abreast  of  his  time,  if  not  ahead  of  it,  for  it  was  not  till  ten 
or  twenty  years  later  that  the  recommendation  ol  incision  took 
definite  shape.  But  the  story  reads  as  if  the  long  incision  was 
an  after-thought  begotten  of  the  difficulty  in  delivering  the  thick 
collodial  contents. 

However  this  may  be,  we  must  "^ve  to  the  Glasgow  surgeon 
credit  for  successfully  performing  a  bold  operation  even  if  it 
was  not  ovariotomy. 

One  other  argument  brought  forward  by  Doctor  "Flnlayson 
must  be  considered,  and  this  is  the  fact  that  "it  was  admitted 
as  a  genuine  case  of  ovariotomy  by  Doctor  Atlee  as  far  back 
as  1849." 

It  is  indeed  probable  that,  but  for  Atlee,  Houstoun's  claim 
would  never  have  arisen.  There  were  two  brothers  Atlee, 
equally  well-known  as  ovariotomists,  the  one  referred  to  is 
Washington  L.  Atlee. 

Now,  there  are  some  curious  and  noteworthy  points  about 
this  table.  First,  in  not  one  of  the  three  cases  which  he  puts 
above  McDowell  does  he  pretend  that  a  tumor  was  removed. 
The  first  was  simply  opening  of  an  abscess;  and  in  the  second 
the  tumor  was  made  to  slough  by  the  use  of  tents;  in  the  third 

154 


DROPSY  OF  OVARY  CURED  BY  ROBERT  HOUSTOUN 

the  cyst  wall  was  stitched  to  the  wound  margin.  He  would  put 
Houstoun's  case  in  front  of  all  these.  Does  this  prove  that  Atlee 
believed  that  Houstoun  removed  an  ovarian  tumor?  Secondly, 
no  dates  are  affixed  to  the  three  first  operations.  It  is  perhaps 
scarcely  fair  to  point  out  that  even  if  they  had  been  removals 
of  ovarian  tumors  (which  he  does  not  pretend  that  they  were) 
they  were  all  subsequent  to  McDowell's  first  case.  The  truth 
of  the  matter  would  seem  to  be  that  Atlee  put  anything  and 
everything  into  his  table  which  was  of  the  nature  of  gastrotomy 
for  tumors.  He  even  includes  Lizars'  case,  in  which  there  was 
no  tumor.  The  table  of  Churchill  in  the  Dublin  Medical  Journal^ 
and  of  Jeaffreson,  in  the  London  Medical  Gazette,  had  appeared 
a  year  or  more  before  Atlee's  table,  and  were  singularly  complete. 

JeaflFreson  classified  the  cases  into  those  in  which  a  tumor 
was  removed  and  those  where  there  was  no  tumor  found  or 
where  removal  was  not  carried  out.  If  ovariotomy  meant  to 
Atlee  what  it  did  to  Jeaffreson,  and  what  it  does  to  us — namely, 
removal  of  a  growth — his  tables  do  not  show  it. 

In  Atlee's  sense,  Houstoun  was  an  ovariotomist,  but  he  did 
not  claim  that  he  removed  an  ovarian  tumor;  he  simply  calls 
the  case  "ovarian  dropsy  cured  by  the  long  incision." 

It  is  proved  that  Atlee  classified  as  ovariotomies  cases 
where  tumors  or  even  abscesses  were  merely  incised;  and  further, 
Atlee  does  not  claim  that  Houstoun  removed  an  ovarian  growth 
but  merely  "cured  an  ovarian  dropsy  by  the  long  incision." 
Other  arguments,  all  pointing  in  the  same  direction,  might  be 
adduced.  I  have  confined  myself  to'^eeting  and  answering 
those  which  have  been  brought  forward  by  Houstoun's  chief 
supporters,  and  the  conclusion  I  come  to  is  that  the  only  answer 
possible  to  the  question,  "Was  Robert  Houstoun,  of  Glasgow, 
the  first  Ovariotoitiist?"  is  "No." — Practitioner,  London,  1897, 
Vol.  Iviii. 

In  a  paper  by  Dr.  W.  L.  Atlee,  a  table  of  all  the  known 
operations  of  ovariotomy,  from  1701  to  1851:  (Trans,  of 
Am.  Med.  Asso.,  1851)  the  names  of  L'Aumonier,  Dzondi 
and  Galenzov^ski,  are  made  to  precede  that  of  McDowell. 

The  claims  of  these  supposed  predecessors  have  been 
effectively  disposed  of  by  Gross,  Bozeman  and  others, 

155 


EPHRAiM  McDowell 

many  years  ago.  Houstoun's  case,  which  Atlee  included 
in  a  subsequent  reference,  and  which  has  been  fully  dealt 
with  above,  was  not  an  extirpation,  but  only  an  incision 
into,  and  drainage  of  the  tumor.  Dzondi's  case  was  not 
even  in  the  female  sex.  It  involved  a  circumscribed  tumor, 
the  size  of  a  head,  occupying  the  hypogastric  region  in  a 
twelve-year-old  lad,  by  the  name  of  Christopher  Shultz. 
It  was  treated  by  incision,  drainage  through  the  aid  of 
tents,  and  the  removal  of  the  sac  in  small  installments 
by  means  of  a  forceps. 

Furthermore,  Dzondi  never  claimed  this  as  a  case  of 
extirpation  of  the  ovary,  or  made  any  claims  to  priority 
over  McDowell,  since  the  operation  was  performed  in 
1816,  or  about  seven  years  after  McDowell's  first  case. 
Others  made  these  claims  for  him. 

The  case  of  Galenzowski,  of  Wilna,  was  a  large  multi- 
locular  cyst  with  unsurmountable  adhesions.  He  incised 
it,  broke  up  the  cysts  with  his  hand,  effected  a  drainage 
and  a  cure  with  a  small  remaining  fistula  in  the  hypo- 
gastric region.  This  case  was  obviously  one  of  incision 
and  drainage,  and  not  of  extirpation;  but  what  is  still 
more  to  the  point,  it  occurred  not  prior  to  McDowell's 
first  ovariotomy  but  eighteen  years  thereafter,  i.e.,  in 
March,  1827.  The  patient's  name  was  Anna  Rudnicki, 
a  widow. 

The  case  of  L'Aumonier,  of  Rouen,  was  that  of  a  pelvic 
abscess  following  parturition,  in  which  he  simply  incised 
and  drained  the  abscess,  with  no  thought  or  suggestion 
of  an  ovariotomy.  This  occurred  in  1776.  All  of  these 
are  but  concrete  illustrations  of  the  confusion,  errors,  and 
contradictions  that  are  interwoven  with  the  life  and  the 
work  of  McDowell. 

Through  the  vigorous  defense  of  Gross,  according  to 
Bozeman,  Atlee  became  convinced  of  his  error,  and  in 

156 


DROPSY  OF  OVARY  CURED  BY  ROBERT  HOUSTOUN 

reparation  for  the  injustice  done  McDowell,  he  dedicated 
his  work  upon  ovarian  tumors  as  follows: 

To  the  memory  of  Ephraim  McDowell,  M.D.,  of  Kentucky, 
the  Founder  of  Ovariotomy  in  1809,  and  to  John  L.  Atlee,  Sr., 
M.D.,  of  Pennsylvania,  my  Brother,  Preceptor,  and  Friend, 
who  since  1843  has  Aided  in  Establishing  this  American  Opera- 
tion, I  Dedicate  this  Volume,  the  Fruits  of  my  Experience  and 
Observation. 

While  a  complete  account  of  the  development  of  ovari- 
otomy, dealing  with  the  debates,  before  and  after 
McDowell,  and  the  details  of  its  development  and  prog- 
ress, as  it  oscillated  forward  and  backward  until  it  was 
firmly  established,  is  extremely  interesting,  it  is,  however, 
beyond  the  aim  and  scope  of  the  present  work,  and  is 
entitled  to  a  volume  in  itself.  Therefore,  we  must  content 
ourselves  with  a  brief  review  of  the  development  of 
ovariotomy  before  and  after  the  publication  of  his  first 
paper  in  18 17. 

As  previously  referred  to,  the  removal  of  healthy 
ovaries  is  said  to  have  been  practiced  by  the  ancients  and 
during  the  middle  ages,  for  immoral  purposes.  The 
thought  of  extirpating  abnormal  ovaries  as  a  curative 
measure  originated,  so  far  as  our  knowledge  goes,  with 
F.  Plater,  of  the  University  of  Basle,  in  1680,  and  Schor- 
kopfF,  in  1685. 

In  the  beginning  of  the  eighteenth  century,  Houstoun 
performed  his  operation  of  incision  and  drainage  of  an 
ovarian  cyst. 

Some  time  after  Houstoun,  and  largely  through  the 
efforts  of  such  French  surgeons  as  LeDran,  in  1736, 
Marjolin,  and  Morand,  Houstoun's  idea  received  distinct 
recognition  and  a  certain  measure  of  adoption.  Delaporte, 
in  1755,  and  prior  to  William  and  John  Hunter,  suggested 
the  extirpation  after  an  unsatisfactory  experience  with 

157 


EPHRAiM  McDowell 

drainage.  This  idea  of  incision  and  drainage,  for  a  time, 
became  an  established  procedure  which  was  recognized  after 
the  advent  of  McDowell's  ovariotomy,  with  which  it 
came  into  active  competition,  especially  with  the  French. 

Ovariotomy  in  the  accepted  term,  is  a  product  of  the 
nineteenth  century,  having  its  origin  with  McDowell  in 
America,  in  1809. 

The  first  successor  of  McDowell  in  the  United  States 
was  Dr.  Nathan  Smith,  a  man  of  unusual  ability,  and  a 
rare  worker  in  his  profession,  who  at  that  time  was  the 
professor  of  surgery  in  Yale  University.  The  operation 
was  performed  at  Norwich,  Vermont,  on  July  5,  1821. 

The  second  successor  was  Dr.  Alban  G.  Smith,  whose 
intimate  association  with  McDowell  entitles  him  to  more 
than  a  passing  notice.  Alban  G.  Smith,  whose  name  was 
changed  to  Alban  Goldsmith  by  an  act  of  the  New  York 
Legislature  came  from  Danville,  Ky.  He  was  a  partner 
and  an  assistant  of  McDowell,  and  was  the  third  successful 
ovariotomist  in  America.  The  operation  was  performed 
May  24,  1823.  He  is  credited  with  being  the  first  in  the 
United  States  to  practice  lithotrity.  This  knowledge  he 
acquired  from  no  less  a  person  than  Civiale  during  a 
visit  to  Europe.  Desiring  a  larger  field.  Goldsmith  moved 
to  Louisville,  and  during  his  residence  in  this  city,  he 
procured  in  1833  a  charter  from  the  legislature  for  the 
"Medical  Institute,"  which  was  really  the  beginning  of 
the  University  of  Louisville.  From  Louisville  he  moved 
to  Cincinnati  accepting  a  professorship  of  surgery  in 
one  of  the  schools  of  that  city;  in  1837  he  was  called  to 
New  York  as  lecturer  on  surgery  in  the  College  of  Physi- 
cians and  Surgeons.  Here  he  continued  to  the  close 
of  his  career. 

His  son,  Middleton  Goldsmith,  after  an  active  career 
in  New  York  City  and  as  Federal  brigade  surgeon  during 

158 


EARLY  PROGRESS  OF  OVARIOTOMY 

the  Civil  War,  again  settled  for  a  time  in  Louisville,  where 
he  reorganized  the  Kentucky  School  of  Medicine.  This 
he  relinquished  owing  to  strong  factional  feeling  following 
the  war,  and  removed  to  Rutland,  Vermont.  His  first 
removal  to  Louisville  was  in  1856,  when  he  was  called 
to  the  chair  of  surgery,  and  later  to  the  deanship  in 
the  Kentucky  School  of  Medicine.  Like  his  father  be- 
fore him,  he  was  a  man  of  parts  and  of  uncommon  ability. 

The  third  successor  to  McDowell  was  Dr.  David  L. 
Rogers,  of  New  York.  This  operation  was  performed  in 
New  York,  September  14,  1829.  Doctor  Rogers  was  not 
the  third  to  attempt  the  operation,  but  he  was  the  third 
who  successfully  performed  it. 

Gallup  attempted  it  in  June  12,  1824.  The  operation 
was  an  incomplete  one,  and,  according  to  Peaslee,  it  was 
probably  not  an  ovarian  cyst.  The  patient  died  on  the 
6th  day  of  tetanic  symptoms. 

Doctor  Trowbrid^,  of  New  York,  attempted  the 
operation  on  April  20, 1827,  but  was  compelled  to  desist, 
owing  to  adhesions.  Mussey's  operation  upon  Mrs.  Sly, 
of  Ryegate,  was  performed  in  the  summer  of  1828,  but,  as 
it  terminated,  it  proved  to  be  a  case  of  incision  and  drain- 
age without  the  removal  of  the  sac,  and,  therefore,  not 
an  ovariotomy. 

Dr.  J.  Bellinger,  of  Charleston,  South  CaroHna,  also 
attempted  the  operation  in  1828. 

On  December  23,  1835,  Bellinger,  performed  the  oper- 
ation upon  a  negress  with  success.  This  seems  to  be  the 
last  ovariotomy  in  the  United  States  until  1843,  when 
Dr.  A.  Dunlap  and  Dr.  John  L.  Atlee  had  their  first  cases, 
the  former  of  which  was  unsuccessful.  Thus,  up  to  the 
time  of  Atlee  and  Dunlap,  in  1843,  the  operation  was 
accomplished  in  America,  aside  from  McDowell,  by  but 
four  men.    These  were  Drs.  Nathan  Smith,  Alban  Gold- 

159 


EPHRAiM  McDowell 

smith,  David  L.  Rogers  and  John  Bellinger.  For  a  period 
of  about  twelve  years  after  McDowell's  death,  the  opera- 
tion seems  to  have  fallen  into  disuse.  The  only  ovari- 
otomy performed  during  this  time  was  Bellinger's  case 
in  December,  1835. 

Here  a  brief  reference  to  a  later  ovariotomist,  Joshua 
T.  Bradford,  who  for  his  time  held  the  record  as  the  most 
successful  operator,  but  for  some  unknown  reason 
passed  into  temporary  obscurity,  is  not  without  interest. 
Joshua  Taylor  Bradford  was  born  in  Bracken  County, 
Kentucky,  December  9,  1818,  the  son  of  William  Brad- 
ford, of  Virginia,  and  Elizabeth  Johnson.  He  was  edu- 
cated in  Augusta  College,  and  studied  medicine  with  his 
brother,  Dr.  J.  J.  Bradford,  graduating  in  1839,  from  the 
Transylvania  University.  From  the  beginning  of  his 
career  he  directed  his  attention  to  surgery.  The  elder 
L.  P.  Yandell  in  speaking  of  Bradford  in  his  memo- 
rial sketch  in  the  Transactions  of  the  eighteenth  meet- 
ing of  the  Ky.  State  Med.  Soc,  says: 

And  it  was  not  long  before  he  became  the  foremost  surgeon 
of  Kentucky,  and  of  all  the  West,  in  that  affection.  Nor  is  it 
too  much  to  say  that  at  the  time  of  his  death  he  stood  first 
among  surgeons  everywhere — in  Europe  and  in  our  own  country 
— as  an  ovariotomist.  Not  that  he  had  done  the  operations 
oftener  than  any  other  surgeon.  Such  is  not  the  fact.  It  has 
been  performed  much  oftener  by  Atlee,  Wells,  Dunlap,  and 
others;  but  by  none  with  the  measure  of  success  that  crowned 
his  operations.  In  the  hands  of  the  surgeons  just  mentioned 
the  recoveries  were  respectively  71,  73  and  80  per  cent.  With 
Bradford  the  cases  in  which  he  operated  successfully  amounted 
to  90  per  cent. 

He  is  credited  with  having  performed  thirty  ovari- 
otomies with  a  mortality  of  ten  per  cent,  the  lowest  on 
record  at  that  time.  This  estabHshed  for  him  the  same 
relationship  towards  ovariotomy  that  Benjamin  Winslow 

160 


EARLY  PROGRESS  OF  OVARIOTOMY 

Dudley  occupied  towards  lithotomy.  Like  Dudley, 
although  not  the  originator  of  ovariotomy,  he  was  at 
that  time  its  most  successful  exponent.  He  continued  to 
practice  in  Augusta,  where  he  was  reared.  He  twice  de- 
clined the  chair  of  surgery,  and  shortly  before  his  death 
he  was  again  urged  to  accept  it  in  Cincinnati.  He  died  in 
the  year  1871  of  an  abscess  of  the  liver. 

That  he  was  inclined  to  be  unambitious  has  been 
pointed  out  by  others.  He  preferred,  it  has  been  said, 
"the  charm  of  his  Piedmont  home  to  the  allurements  of 
professional  life."  This,  however,  hardly  explains  the 
completeness  with  which  he,  for  a  time,  was  lost  to  his 
profession  in  Kentucky.  With  his  passing  he  seemed  in 
an  unusually  short  space  of  time  to  have  been  so  com- 
pletely forgotten  that  in  1907-8,  while  collecting  Ken- 
tucky data  for  Dr.  Howard  A.  Kelly's  Cyclopedia  of 
American  Medical  Biography,  we  seemed  to  have  re-dis- 
covered, this  sturdy  character,  who  belonged  in  a  class 
with  McDowell,  Dudley,  and  Brashear.  As  we  contin- 
ued our  investigation  we  learned  to  our  astonishment  that 
the  older  members  of  the  Louisville  profession,  some  of 
whom  had  directly  interested  themselves  in  McDowell 
and  the  operation  of  ovariotomy,  were  at  that  time  as 
strangely  in  ignorance  of  Bradford  as  we  had  been. 

What  might  be  referred  to  as  the  real  acceptance  of 
ovariotomy  came  in  the  early  '40*8  with  the  Atlees  on 
this  side  of  the  Atlantic,  and  Dr.  Charles  Clay,  in  1842, 
in  Manchester,  England.  This  revival  was  practically 
coeval  with  the  advent  of  anaesthesia.  It  may  justly  be 
referred  to  as  the  second  epoch  in  the  establishment  of 
ovariotomy,  and  was  dependent  rather  upon  the  bene- 
ficent influence  of  this  discovery,  than  upon  the  activity 
or  success  of  any  person  or  persons  on  this,  or  the  other 
side  of  the  Atlantic. 

II  161 


EPHRAiM  McDowell 

To  ask  the  subject  of  an  ovarian  tumor  to  submit  to 
an  abdominal  section,  even  after  the  era  of  anaesthesia, 
was  quite  enough.  But  if  we  add  to  the  primitive  state 
of  surgery,  as  it  then  existed,  with  its  high  mortahty,  and 
its  fears  and  prejudices  against  operations,  the  fear  and 
dread  of  pain  which  through  consciousness  were  added 
before  the  era  of  anaesthesia,  we  wonder  that  any  of 
these  patients  submitted  to  a  proposal  that  involved 
such  terrors  and  uncertainties,  even  though  it  carried 
with  it  a  possible  relief  from  the  misery  which  they 
had  endured.  And  if  through  a  vivid  imagination,  we 
visualize  the  cold  facts,  with  all  the  terror  and  despera- 
tion that  attended  such  conditions  and  operations,  we 
shall  then,  and  only  then,  be  adequately  prepared  to  do 
homage  to  the  earlier  operators  and  their  patients. 

A  proper  realization  of  such  distressing  details  will 
emphasize  our  conclusion,  that  the  honors  of  ovari- 
otomy should  be  divided  equally  between  Ephraim 
McDowell  and  Jane  Todd  Crawford.  The  thoughtless- 
ness with  which  she  has  been  ignored  in  the  past  is  after 
all  a  sad  commentary  upon  our  present-day  conception 
of  justice  and  gratitude. 

In  March,  1842,  Dr.  Crawford  W.  Long,  of  Georgia, 
proved  the  anaesthetic  properties  of  ether,  and  in  October, 
1846,  Warren,  in  the  Massachusetts  General  Hospital, 
again  demonstrated  these  properties  and  their  surgical 
uses.  Although  Warren  was  not  the  first,  his  demon- 
stration attracted  more  attention,  and,  therefore,  bore 
more  fruits  than  Long's  demonstration. 

With  the  operation  as  performed  by  McDowell  upon 
a  sound  surgical  basis  and  with  the  advent  of  anaesthesia, 
which  eliminated  the  principal  horrors  of  surgery,  fear 
and  pain,  ovariotomy  soon  began  to  be  practiced  with 

162 


EARLY  PROGRESS  OF  OVARIOTOMY 

increasing  frequency.  With  this  second  epoch  in  the 
estabhshment  of  ovariotomy  came  a  series  of  debates 
upon  the  propriety  of  the  operation,  that  strongly  reminded 
us  of  the  debates  that  occurred  before  the  time  of 
McDowell,  and  that  revolved  about  the  possibility 
of  the  operation.  McDowell,  through  his  results  having 
put  a  quietus  on  the  debates  upon  the  possibility  of  the 
step,  the  discussions  broke  out  with  added  furore  upon 
its  propriety.  These  latter  debates,  like  those  before 
the  time  of  McDowell,  did  not  occur  in  any  one  country, 
but  occurred  more  or  less,  in  every  country  where  the 
accepted  surgery  of  that  day  was  practiced. 

In  the  United  States  we  had  such  men  as  Nathan 
Smith,  Alb  an  Goldsmith,  Rogers,  and  Bellinger,  all  of 
whom,  save  the  latter,  performed  the  operation 
before  the  passing  of  McDowell,  and  after  that  period, 
principally  the  two  Atlees,  Dunlap,  and  Kimball,  as  advo- 
cates of  its  propriety  and  adoption. 

On  the  negative  side  of  this  question  we  find  among 
others  such  names  as  Prof.  Mutter,  Prof.  Chas.  D.  Meigs, 
of  Philadelphia,  Prof.  Joshua  B.  Flint,  of  Louisville, 
Liston  and  Robert  Lee,  of  London,  and  Mathews  Duncan, 
of  Edinburgh. 

Dr.  Washington  L.  Atlee,  in  his  address  before  the 
Philadelphia  County  Medical  Society,  delivered  February 
I,  1875,  while  reviewing  the  indignities  to  which  he  was 
exposed,  gives  the  local  coloring  of  the  opposition,  as  it 
appeared  in  Philadelphia,  thus: 

From  the  earliest  period  of  ovariotomy  in  Philadelphia, 
down  to  the  present  time  it  has  been  my  invariable  custom  to 
invite  members  of  the  profession  to  witness  the  operation  in 
order  that  they  might  be  able  to  form  a  proper  opinion  of  its 
character  and  to  judge  of  its  propriety. 

163 


EPHRAiM  McDowell 

It  was  a  rare  circumstance  during  the  probationary  stage 
of  the  operation  for  anyone  to  accept  the  invitation  cordially 
and  gratefully.  Others  positively  refused  and  emphatically 
condemned  the  innovation,  while  others  took  the  invitation  as 
an  insult. 

Gentlemen  who  were  bold  enough  to  witness  the  manipula- 
tion were  even  directly  accused  by  their  professional  acquaint- 
ances of  being  "particeps  criminis"  in  committing  murder:  not- 
withstanding these  murder  patients  recovered.  Some,  high  in 
the  profession,  against  all  ethical  considerations,  would  call 
upon  the  patient  who  had  fully  decided  upon  the  operation  for 
the  purpose  of  warning  them  against  me  and  certain  death. 

Sometimes  the  professors  would  go  out  of  their  way  to  de- 
nounce it.  One  eminent  surgeon,  now  dead,  after  the  occurrence 
of  a  fatal  case,  in  185 1,  opened  his  lecture  on  surgery  in  words 
like  these:  "Gentlemen,  it  is  my  painful  duty  to  announce  to 
you  that  a  respectable  lady  who,  a  few  days  ago  came  from  New 
York  to  this  City  with  an  ovarian  tumor,  which  was  removed 
by  Doctor  Atlee,  returned  to  that  City  today  a  corpse."  This 
was  particularly  marked,  as  it  had  no  relation  to  the  subject  of 
that  lecture.  It  was  not  uncommon  for  medical  men  to  refuse 
to  meet  me  in  consultation  for  no  other  reason  than  my  persist- 
ence in  performing  ovariotomy. 

A  prominent  surgeon  then  belonging  to  the  staff  of  the 
Pennsylvania  Hospital,  upon  being  called  out  at  night  to  see 
one  of  my  patients,  when  I  was  sick  in  bed,  after  prescribing 
and  without  his  having  been  solicited  to  join  in  the  treatment 
of  the  case,  voluntarily  said:  "Tell  Doctor  Atlee  that  I  will  not 
meet  him  in  consultation  because  he  undertakes  to  perform 
operations  not  recognized  by  the  profession."  Another  in 
passing  along  Arch  Street,  opposite  my  house  in  company 
with  others  exclaimed  "There  lives  the  greatest  quack  in 
Philadelphia."  And  yet  this  same  gentleman  is  now  an 
ovariotomist  himself. 

In  France,  Cazeaux,  almost  single-handed,  fought  the 
French  Academy  of  Medicine  in  a  discussion  upon  ovarian 
cysts  and  their  treatment,  that  lasted  from  October,  1856, 
to  the  following  February,  and  that  included  in  the  oppo- 

164 


EARLY  PROGRESS  OF  OVARIOTOMY 

sition    such    names    as   Velpeau,    Cruveilhier,    Cloquet, 
Malgaigne,  Guerin,  Trousseau,  and  others. 

Peaslee  has  given  us  a  number  of  the  keen  expressions 
indulged  in  during  this  discussion,  to  wit: 

Malgaigne:  "A  great  deal  has  been  said  in  America  and 
France  respecting  the  extirpation  of  ovarian  cysts;  an  operation 
too  radical,  as  it  seems  to  me,  and  of  a  nature  to  place  patients 
too  absolutely  beyond  all  resource  .  .  .  The  alleged  statistics 
prove  nothing.  All  know  what  statistics  are  worth  when  all 
the  successes  are  collected,  and  the  reverses  are  omitted," 

Cruveilhier:  "Although  it  has  been  performed  quite  a  large 
number  of  times  with  success,  especially  in  England  and  in 
America,  I  do  not  think  that  this  daring  operation  should  be 
allowed  a  citizenship  in  France;  success  does  not  always  justify 
rash  proceedings." 

Huguier:  "In  spite  of  the  statistics,  we  reject  it  in  a  manner 
almost  absolute." 

Velpeau:  "The  extirpation  of  diseased  ovaries  is  a  frightful 
operation,  which  ought  to  be  proscribed,  though  the  cures 
announced  were  real." 

Moreau:  "For  myself  I  think  this  operation  should  be 
placed  among  the  prerogatives  of  the  executioner." 

Cazeaux,  who  alone  raised  his  voice  in  defense  of  the 
operation,  said  in  closing: 

Finally,  is  there  nothing  better  to  be  done  in  these  unfortu- 
nate cases  than  to  abandon  patients  to  a  certain  death?  ...  I 
will  only  touch  upon  this  question,  for  I  know  that  my  answer 
will  meet  with  but  little  sympathy  in  this  circle,  and  that,  to 
justify  it,  I  should  be  obliged  to  speak  too  much  at  length.  But 
I  will  not  leave  this  stand  without  protesting  against  the  ana- 
thema hurled  by  several  speakers  against  extirpation  of  the 
ovaries  ...  I  believe  that,  before  proscribing,  we  should 
examine,  and  that  a  sufficiently  serious  examination  has  not  yet 
been  made  .  ,  .  Reserved  for  multilocular  and  areolar  cysts,  for 
those  whose  fluid  is  albuminous  or  gelatinous,  I  do  not  hesitate 
to  declare  my  conviction  that  the  operation  is  fully  justifiable. 

Do  not  forget,  he  added,  that  I  speak  of  an  ovarian  cyst, 
and  one  of  the  worst  kind;  that  when  these  malign  tumors  have 

165 


EPHRAiM  McDowell 

acquired  a  large  size  they  kill  in  a  very  short  time,  and  that, 
before  killing,  they  produce  such  sufferings  that,  to  many  of 
these  unfortunates,  death  seems  preferable  to  life.  Now,  in 
these  circumstances,  an  operation  is  proposed  which  has  already 
had  numerous  successes,  and  you  reject  it  with  disdain.  Well, 
I  assert  that  your  indignation  is  not  legitimate,  and  that  you 
have  no  right  not  to  instruct  families  as  to  the  resources  it 
affords  to  patients  suffering  thus.  Every  day  surgeons  are 
performing  operations  quite  as  grave,  for  diseases  whose  symp- 
toms are  not  more  pressing. — Peaslee. 

In  Germany  the  debates  hardly  reached  this  degree  of 
intensity.  We  find  such  men  as  Chrysmar  of  Isny,  Martin 
of  Liibeck,  and  Biihring  of  Berlin,  favoring  the  operation; 
and  notably  among  the  opponents  was  DiefFenbach,  who, 
as  late  as  1843,  spoke  of  ovariotomy  as  sheer  murder. 

One  noteworthy  feature  is  that  the  general  surgeons 
were  inclined  to  oppose  the  procedure,  while  the  obstetri- 
cians favored  it.  An  exception  to  this  rule  was  Prof. 
Charles  D.  Meigs,  professor  of  obstetrics  in  Philadelphia, 
who  bitterly  denounced  McDowell  and  challenged  his 
veracity.  In  this  country  Physick  turned  McDowell 
down  cold,  while  James  welcomed  the  procedure  and 
encouraged  McDowell  in  every  way  that  he  could.  This 
was  similar  to  what  occurred  in  Great  Britain,  where 
the  Obstetrical  Society  of  London  raised  no  objection  to 
the  principle  of  ovariotomy,  though  a  few  members  were  for 
a  time  at  least  opposed  to  it.  The  surgeon-accoucheur 
Cazeaux  opposed  the  French  Academy  of  Medicine,  which 
had  as  its  members  the  most  noted  surgeons  in  France, 
who  were  equally  celebrated  at  that  time  throughout 
the  world. 

According  to  Fehr,  the  first  successful  ovariotomy  per- 
formed in  Europe  was  by  an  Italian,  Doctor  Emiliani,  in 
Faenza,  in  the  year  181 5.  If  this  is  correct,  it  constitutes 
the  first  successful  ovariotomy  that  was  performed  out- 

166 


EARLY  PROGRESS  OF  OVARIOTOMY 

side  of  the  United  States,  and  would  make  Doctor  Emiliani 
the  second  ovariotomist  in  the  world.  It  is  notable  that 
this  date  is  about  six  years  after  McDowell's  first  venture, 
but  what  is  of  more  importance  is  that  it  was  about  two 
years  before  the  publication  of  his  first  report. 

Since  Emiliani's  case  has  repeatedly  been  referred  to 
in  literature,  and  since  in  view  of  the  date,  it  is  of  distinct 
historical  interest,  we  have  prepared  an  abstract  of  the 
report  as  it  appeared  in  the  Bulletino  della  Scienza 
Mediche  Bologna,  1843. 

This  paper  was  read  before  the  Medico-Chirurgical 
Society  of  Bologna,  by  Dr.  Emilio  Emiliani,  and  represents 
the  report  of  an  operation  performed  by  his  father.  Doctor 
Gaetano  Emiliani,  twenty-eight  years  before.  The  title 
of  the  paper  is  Storia  della  Estirpazione  di  una  Ovaia 
eseguita  dal  Prof.  Gaetano  Emiliani  redatta  dal  dottor 
Emilio  Emiliani  de  Faenza. 

The  case  report  is  as  follows : 

Rosalia  Ghetti,  of  Faenza,  aged  twenty-six  years,  a  baker's 
wife.  She  was  of  lymphatic  temperament,  menstruated  regu- 
larly and  aside  from  the  exanthemata  in  childhood,  enjoyed 
good  health.  She,  had  given  birth  to  three  children,  the  last 
of  whom  was  a  nursing  infant.  Although  unaccustomed  to  work, 
she  did  some  washing,  using  a  board  that  pressed  against  the 
lower  part  of  her  abdomen.  She  felt  no  discomfort  from  this  at 
the  time,  but  during  the  night  she  was  awakened  by  a  pain  in 
the  left  iliac  region.  After  suffering  for  several  days  she  called 
Dr.  Girolamo  Brunetti,  who  discovered  a  tumor,  not  visible  on 
inspection,  but,  partly  definable  and  painful  on  palpation. 

Blood-letting  and  the  commoner  remedies  were  tried  with- 
out avail.  He  then  tried  hemlock,  mercurials,  and  other  reme- 
dies of  similar  action,  together  with  irrigation  of  warm  water. 
After  a  lapse  of  four  months  without  any  improvement  she  was 
thought  to  be  pregnant,  and  the  treatment  was  limited  to  rubbing 
with  olive  oil.  Two  months  thereafter  and  attended  with  a 
considerable  hemorrhage  she  passed  a  large  "Mola."    She  con- 

167 


EPHRAiM  McDowell 

tlnued  to  have  a  slight  flow  of  blood  for  twenty-five  days,  when 
she  began  to  have  a  rise  in  temperature. 

At  this  juncture  Dr.  Gaetano  Emiliani,  the  surgeon,  was 
called.  She  had  continuous  fever,  with  a  chill  in  the  evening, 
thirst,  dry  tongue,  restlessness,  anorexia,  insomnia,  constipation 
and  diminished  urine,  high-colored  but  without  sediment. 
Nutrition  fairly  good. 

The  tumor  was  hard  and  attended  with  spasmodic  pains, 
but  with  no  abnormal  external  appearance  on  inspection.  The 
symptoms  indicated  "scirrosa"  condition  of  the  ovary  with 
possibly  a  "carcinoma."  The  only  remedy  seemed  an  extirpa- 
tion. This  met  with  the  approval  of  the  family  doctor,  as 
the  temperature  continued  high  and  the  lancinating  spas- 
modic pains  had  increased.  Dejections  of  a  fluid  and  offen- 
sive character  occurred,  and  the  urine  increased  with  abundant 
colored  sediment. 

There  was  present  at  the  operation  Doctor  Brunetti  and 
the  phlebotomist,  Mr.  Antonio  Bucci,  together  with  some  rela- 
tives of  the  patient.  My  father  incised  the  integument  along 
the  linea  alba  for  about  two  and  one-half  inches.  He  divided 
the  underlying  muscles,  and  carefully  the  peritoneum.  This 
brought  him  to  the  left  ovary  as  identified  by  its  form,  position, 
and  connections,  although  unusually  enlarged.  The  upper  part 
was  covered  with  small  vesicles,  from  which  upon  incision  foetid 
liquid  escaped.  It  was  adherent  to  the  lower  portion  of  the 
colon.  Surrounding  it  were  varicosed  vessels.  It  was  easily 
separated  from  its  adhesions  and  usual  connection,  ligating  the 
vessels  as  they  appeared.  The  loss  of  blood  amounted  to  about 
one-half  a  pound.  The  wound  was  closed  and  dressed  with 
compresses  and  a  tight  bandage. 

The  day  following  the  fever  was  higher,  with  great  thirst 
and  anorexia.  She  was  subjected  to  a  blood-letting,  which  was 
repeated  the  next  day.  In  addition  she  was  given  tartar  emetic 
and  large  quantities  of  lemonade.  The  wound  was  dressed  for  the 
first  time  on  the  third  day,  and  in  the  presence  of  several  surgeons. 
It  was  doing  satisfactorily,  with  but  little  signs  of  suppuration. 

On  the  eleventh  day  there  was  no  fever,  and  in  a  short  time 
she  was  again  in  good  health.  The  menstrual  flow  returned,  and 
in  a  year  thereafter  she  gave  birth  to  twins,  who  lived  but  a  few 
hours.    Later  on  two  more  children  were  born  to  her,  who  died 

168 


EARLY  PROGRESS  OF  OVARIOTOMY 

in  infancy.  After  these  she  gave  birth  to  a  son,  who  died  in 
adolescence  from  scrofula,  and  two  daughters,  who  are  healthy 
and  living. 

The  ovary  after  twenty-eight  years  in  alcohol  appears  pyri- 
form,  and  measured  nine  centimeters  in  length  and  five  in  width. 

In  view  of  the  fact  that  the  report  was  not  made  by 
the  operator,  but  by  his  son  from  papers  left  by  his  father, 
and  twenty-eight  years  after  its  performance,  and  that 
the  clinical  history  of  the  case  is  hardly  one  of  an 
ovarian  tumor;  together  with  statements  from  other 
Italian  operators,  placing  the  date  of  the  first  ovariotomy 
in  Italy  many  years  later,  and  to  the  credit  of  another; 
Emiliani's  case  seems  surrounded  with  too  much  doubt 
to  be  credited  with  being  second  to  the  ovariotomies  of 
McDowell,  or  for  Dr.  Gaetano  Emiliani  to  be  referred 
to  as  the  second  ovariotomist  in  the  world. 

In  Peaslee's  work  we  find  a  record  of  the  assertions, 
made  by  Italian  writers,  that  the  first  ovariotomy  was 
performed  in  Italy  in  January,  1865,  by  Dr.  Dominico 
Peruzzi,  of  Sinigaglia  {The  Lancet,  January,  1865  and 
1869),  that  Professor  Bezzi  {London  Med.  Times  and  Gaz.j 
Sept.  3,  1865),  was  the  second  operator  with  the  first 
success.  Doctor  Feoratini  in  The  Ippocratio  for  January, 
1868,  states  that  up  to  that  time  there  had  been  but 
seven  ovariotomies  in  Italy,  and  all  had  proved  fatal 
{The  Lancet,  1868,  vol.  i). 

Spencer  Wells  in  his  work  upon  the  ovaries  says: 

In  Italy,  the  first  successful  ovariotomy  was  performed 
by  Professor  Landi,  of  Pisa,  in  September,  1 868 ;  the  second, 
by  Professor  Peruzzi,  of  Lugo,  in  1869;  the  third,  by  Doctor 
Marcolo,  of  Padua,  in  July,  1871.  In  his  account  of  this 
operation.  Doctor  Marcolo  says  that  it  is  the  sixteenth 
ovariotomy  performed  in  Italy,  the  results  having  been 
three  recoveries  and  thirteen  deaths;  and  he  joins  with 

169 


EPHRAiM  McDowell 

Landi  in  urging  his  countrymen,  by  courage  and  persever- 
ance, to  emulate  the  successes  of  their  EngHsh  brethren. 

If  we  consider  the  special  features  of  Emiliani's  case, 
together  with  the  contradictory  statement  of  his  own 
countrymen,  we  can  hardly  successfully  balance  his 
claims  against  the  claims  of  Chrysmar  of  Isny  as  the 
second  ovariotomist. 

It  is  true  that  Chrysmar's  cases  were  reported  after 
his  death  and  through  another.  However,  the  time  that 
elapsed  was  but  eight  years  instead  of  twenty-eight  years; 
the  report  was  made,  not  from  papers  left  by  the  operator, 
but  by  one  who  assisted  in  the  operation;  lastly,  the 
clinical  descriptions  more  clearly  establish  the  identity  of 
the  tumors  in  Chrysmar's  cases  than  in  Emiliani's,  as 
being  of  an  ovarian  origin.  He  performed  the  operation 
May  i6th,  1819,  almost  ten  years  after  McDowell's  oper- 
ation, and  less  than  two  years  after  his  first  publication. 
Hence,  from  all  available  evidence,  the  conclusion  seems 
justifiable  that  to  Chrysmar  is  due  the  distinguished  honor 
of  having  been  the  first  successor  to  McDowell,  irrespec- 
tive of  country. 

Like  McDowell,  he  was  an  able  but  comparatively  ob- 
scure practitioner  in  the  small  Wiirtemberg  town  of  Isny. 
It  is  not  definitely  known  whether  Chrysmar  was  ac- 
quainted or  not  with  McDowell's  first  report,  which  ap- 
peared in  1 817.  Situated  as  he  was,  more  or  less  remote 
from  large  centers,  in  a  time  when  exchange  of  communica- 
tions was  far  from  what  it  is  to-day,  it  is  possible  that  he 
was  unacquainted  with  McDowell's  work.  In  that  event, 
the  importance  of  his  efforts,  and  the  credit  to  which  he 
would  be  entitled  would  be  second  and  almost  equal  to  the 
importance  and  the  credit  due  to  McDowell  alone. 

In  any  case,  in  full  agreement  with  the  suggestion 
made  by  others,  we  believe  that,  like  McDowell,  Chrysmar 

170 


CHRYSMAR'S  CASES 

should  by  his  countrymen  be  honored  with  a  monument, 
memoriahzing  his  deeds  of  courage  and  usefulness. 

Chrysmar's  three  cases  were  reported  by  Doctor 
Hopfer,  of  Biberach,  who  assisted  in  the  operations,  and 
who  was  prompted  to  report  the  cases  after  reading  the 
report  of  John  Lizars'  "Extirpation  of  Diseased  Ovaria." 

The  report  is  filled  with  details  that  are  omitted  in 
this  abstract. 

Case  I.  The  wife  of  a  German  peasant,  age  forty-seven 
years,  who  gave  birth  to  eight  children.  In  her  last  pregnancy 
she  suffered  from  vomiting,  abdominal  pains  and  extreme  con- 
stipation. Abdominal  symptoms  continued  after  the  termina- 
tion of  this  pregnancy. 

In  the  beginning  of  her  forty-sixth  year  her  abdomen  had 
the  appearance  of  a  pregnancy  of  full  term. 

This  was  variously  treated,  and  variously  diagnosed,  until 
she  came  under  the  care  of  Doctor  Chrysmar,  who  diagnosed  a 
"hardening  and  enlargement  of  the  left  ovary  with  ascites." 

He  proposed  extirpation,  which  advice  was  accepted,  and 
carried  out  on  May  i6,  1819. 

An  incision  was  made  to  the  left  of  the  umbilicus,  extending 
from  the  ensiform  cartilage  to  the  pubes.  Five  maass  of  an 
odorless  green  fluid  escaped.  Extensive  adhesions  to  the  colon; 
stomach  and  abdominal  wall  were  encountered,  and  were  separ- 
ated by  means  of  the  fingers  or  the  end  of  the  bistoury.  The 
pedicle  was  tied  with  a  double  ligature  and  the  tumor  cut  away. 
Hemorrhage  was  comparatively  slight,  requiring  but  two  addi- 
tional ligatures.    The  time  of  operation  was  twenty  minutes. 

She  stood  the  operation  well,  but  soon  thereafter  peritoneal 
symptoms  manifested  themselves,  which  terminated  the  case  in 
thirty-six  hours. 

Shortly  before  the  end  the  bandage  was  removed  and  the 
local  condition  critically  examined,  even  to  the  re-opening  of  the 
abdominal  wound.  The  tumor  weighed  seven  and  one-half 
pounds  "Civil  Weight." 

Case  2.  A  married  woman,  age  thirty-eight  years,  from  B — . 
She  gave  birth  to  five  children,  two  of  which  died  soon  after 
being  born.    The  last  child  was  born  in  her  thirty-first  year. 

171 


EPHRAiM  McDowell 

Shortly  thereafter  disturbances  on  the  left  side  became  apparent. 
After  receiving  medical  attention  at  the  hands  of  several  physi- 
cians, without  avail,  she  drifted  to  Isny  and  came  under  the 
care  of  Doctor  Chrysmar,  who  apprised  her  of  her  condition 
and  advised  an  operation,  which  advice  she  accepted.  Opera- 
tion June,  1820.  An  incision  was  made  similar  to  the  one  in 
the  first  case,  except  that  the  opening  into  the  peritoneal  cavity 
was  cautiously  made,  and  at  first  limited  in  extent.  The  assist- 
ant was  urged  to  prevent  the  escape  of  the  intestines,  by  the 
use  of  his  outstretched  hands  liberally  coated  with  oil.  He 
evidently  had  been  impressed  with  this  importance  from  his 
first  experience.  When  they  did  escape  they  were  received  in 
hot  moist  napkins.  The  pulsating  vessels  filled  the  assistants 
with  fear  and  sympathy.  The  tumor  was  delivered,  tied  with 
a  double  ligature,  and  cut  away.  The  intestines,  which  had  been 
out  of  the  cavity  five  or  six  minutes,  were  returned,  and  the 
abdominal  wound  closed.  The  duration  of  the  operation,  fifteen 
minutes.  The  recovery  was  practically  uneventful,  and  at  the 
end  of  six  weeks  she  returned  home.  The  tumor  weighed  eight 
pounds  "Civil  Weight." 

Case  3.  An  unmarried  woman  from  Scheideck,  Bavaria,  age 
thirty-eight  years,  who  from  childhood  was  crippled  as  the 
result  of  a  tubercular  condition.  Throughout  her  entire  life 
she  was  delicate  and  almost  constantly  under  medical  supervision. 

A^  the  age  of  thirty-two,  a  tumor,  the  size  of  a  child's  head, 
and  located  on  the  left  side  was  discernible.  Later  she  was 
tapped,  and  eight  maass  of  yellow  gelatinous  fluid  removed. 

She  was  referred  to  Doctor  Chrysmar,  of  Isny,  who,  notwith- 
standing the  unfavorable  outlook,  advised  an  operation,  which 
after  due  consideration  was  accepted. 

The  operation  was  performed  in  the  month  of  August.  The 
incision  was  the  same  as  in  the  other  cases,  and  upon  opening 
the  abdomen,  three  maass  of  yellowish-green  foul-smelling  fluid 
escaped.  The  escaped  intestines  were  received  in  warm  moist 
cloths.  The  tumor  was  marked  by  varicose  vessels,  and  adherent 
to  the  promontory  of  the  sacrum.  This  adhesion  was  easily 
divided  with  a  knife.  The  pedicle,  four  inches  in  thickness, 
was  secured  with  a  double  ligature,  and  divided.  The  wound 
was  closed,  and  after  removal  to  her  bed  she  lost  consciousness 
for  eight  minutes.    This  repeated  itself  several  times  until  at 

172 


CHRYSMAR'S  CASES 

the  end  of  thirty-six  hours  she  expired  amid  convulsions.  This 
like  the  other  unfavorable  case  was  subjected  to  a  post-mortem 
examination.  The  tumor  weighed  six  and  one-half  pounds 
"Civil  Weight."  Tubercular  deposits,  more  especially  on  the 
surface  of  the  liver,  and  which  on  section  discharged  a  small 
amount  of  pus,  were  revealed  at  the  autopsy. 

Doctor  Hopfer  concludes  his  article  M^ith  a  sketch  of 
Doctor  Chrysmar. 

Doctor  Chrysmar  was  born  in  Wiirzach,  in  1774,  of 
indigent  parents.  At  an  early  age  he  manifested  unusual 
intellect  and  earnestness.  His  meagre  resources  did  not 
permit  of  any  educational  opportunities,  but  notwith- 
standing this  he  mastered  the  Latin  and  the  German 
languages.  At  the  age  of  sixteen  he  went  to  Vienna  as  a 
surgical  assistant,  and  devoted  all  his  spare  time  to  attend- 
ance on  surgical  lectures  at  the  St.  Joseph's  Institute. 
He  was  much  interested  in  anatomy.  At  last,  through 
great  economy  and  the  assistance  of  others,  he  was  able 
to  matriculate  at  the  University,  where  his  industrious 
habits  attracted  attention.  After  a  residence  often  years 
in  Vienna,  he  graduated,  whereupon  he  settled  as  surgeon 
and  accoucheur  at  Constance.  He  was  soon  called  to 
Isny,  Wiirtemburg;  this  call  he  cheerfully  heeded  owing 
to  its  promixity  to  his  birthplace.  He  rapidly  acquired  a 
high  reputation  as  a  surgeon.  He  read  much,  critically 
studied  every  new  surgical  work,  and  traveled  extensively. 
He  had  a  private  institute  for  treating  his  patients,  to 
which  patients  from  the  surrounding  region  flocke^.  As  a 
man,  a  physician,  and  a  friend,  he  was  highly  esteemed; 
unselfish  devotion  was  his  characteristic. 

He  was  requested  by  Doctor  von  Klein,  of  Stuttgart, 
in  1820,  to  publish  his  principal  operations,  but  was  pre- 
vented by  his  sudden  death  in  1821,  in  his  forty-seventh 
year,  from  "Gout  on  the  Lungs."  He  died  much  too  early 
for  his  family  and  suffering  humanity. 

173 


CHAPTER  IX 

THE  OPPOSITION  OF  THE  EARLY  FRENCH  SCHOOL — ^THE  HISTORY 
OF  AN  EMPHYSEMA,  BY  WILLIAM  HUNTER — THE  r6lE  OF 
THE    BRITISH    SCHOOL. 

According  to  Professor  Hofmeier,  the  first  successful 
vaginal  hysterectomy  for  carcinoma  was  carried  out  three 
years  later  by  an  ordinary  practitioner,  Doctor  Sauter, 
of  Constance,  a  town  near  Isny. 

The  adoption  of  ovariotomy  in  Germany  was  slow. 
This  was  not  because  special  aversion  to  it  existed  in 
Germany,  as  it  did  in  France,  but  because  in  Germany, 
they  considered  it  as  too  dangerous,  and  the  German 
estimate  of  the  risk  was  largely  influenced  by  the  emphatic 
opposition  that  marked  the  discussions  in  the  French 
Academy.  After  these  discussions,  ovariotomy,  which 
had  made  some  progress  in  Germany — at  least  more  than 
it  had  in  France — received  a  distinct  set-back.  This  set- 
back was  again  favorably  influenced  by  the  French,  when 
Nelaton  returned  from  his  visit  to  Baker  Brown  in  1861, 
and  vigorously  espoused  the  cause  of  ovariotomy. 

According  to  Gustave  Simon,  the  well-known  German 
surgeon,  up  to  the  year  1858  sixty-one  operations  were 
performed  or  attempted.  Of  these  sixty-one  patients, 
forty-four,  or  seventy-two  per  cent.,  died  after  the  opera- 
tion, and  only  fourteen  recovered.  According  to  later  sta- 
tistics compiled  by  Doctor  Dutoit  in  the  year  1864,  the  op- 
eration was  performed  or  attempted  seventy-four  times, 
with  fifty-five  deaths. 

Among  the  names  of  those  who  did  most  toward  the 
improvement  and  adoption  of  ovariotomy  in  Germany  are 
Nussbaum,  Hegar,  Olshausen,  Schroeder,  and  Martin. 

Prior  to  the  time  of  McDowell,  and  about  the  middle 

174 


THE  OPPOSITION  OF  THE  EARLY  FRENCH  SCHOOL 

of  the  eighteenth  century,  the  activity  of  the  French 
school  became  aroused.  This  activity  centered  about  the 
incision  and  drainage  as  a  cure  for  ovarian  tumors,  and  re- 
flected the  lesson  which  Houstoun's  experience  taught. 
The  use  of  iodine  was  later  added,  and  grew  in  favor, 
largely  through  the  influence  of  Boinet's  work.  It  was 
taught  that  multilocular  and  serous  cysts  could  be  cured  by 
iodine  injections. 

After  these  procedures  had  for  some  time  been  ener- 
getically discussed  and  reasonably  tried,  they  were  by 
common  consent  discarded  as  inadequate.  Based  on  one 
of  these  failures,  Delaporte  in  1755  advanced  the  idea  of 
excision  as  the  only  certain  method  of  successfully  dealing 
with  this  conditio.n.  In  this  he  was  supported  by  Morand, 
who  quaHfied  his  endorsement  by  advocating  extirpation, 
but  in  the  early  cases.  Morand's  views  were  effectually 
opposed  by  M.  Kevin  in  a  paper  before  the  Royal  Academy 
of  Surgery,  which  stifled  all  expression  until  1798,  when 
Chambon,  after  considering  the  tumors  amenable  to 
excision,  said:  "I  am  convinced  that  a  time  will  come 
when  this  operation  will  be  extended  to  cases  more  numer- 
ous than  those  in  which  we  have  proposed  it,  and  that  no 
objection  will  be  made  to  its  performance." 

About  the  time  of  Delaporte,  Theden,  who  in  litera- 
ture has  been  associated  with  the  French  school,  came 
forward  with  a  carefully  detailed  operation  for  the  excision 
of  these  tumors.  Theden's  operation  was  ably  defended 
by  two  English  surgeons,  Power  and  Darwin. 

It  consisted  of  an  inguinal  incision  down  to  the  cyst. 
This  he  believed  to  be  outside  of  the  peritoneum.  He 
dilates  the  wound  with  his  fingers,  exposing  the  cyst, 
which  he  incises  and  evacuates.  He  then  delivers  the  sac 
and  ligates  the  pedicle,  allowing  the  ligature  to  pass  out 
at  the  lower  angle.    If  the  sac  fails  to  be  delivered,  or  the 

175 


EPHRAiM  McDowell 

tumor  Is  a  solid  one  and  cannot  be  delivered,  he  ligates  the 
pedicle  to  accomplish  the  destruction  of  the  tumor.  If  he  is 
successful  in  the  removal  of  the  sac,  the  wound  is  closed. 

We  have  endeavored  to  identify  Theden  and  give  to 
him  his  proper  place.  Our  efforts  resulted  in  finding  but 
one  Theden,  who  was  the  Surgeon-General  of  the  Prussian 
Army  in  1786. 

Johann  Christian  Anton  Theden,  1714-97,  was  edu- 
cated as  a  barber-surgeon,  and  probably  in  literature 
became  confused  with  the  French  school  through  his 
"Neue  Bemerkungen  und  Erfahrungen  zur  Bereicherung 
der  Wundarzneykunst  und  Medicin,"  pubHshed  in  1771, 
which  contained  some  remarkable  surgical  contributions, 
and  which  passed  through  a  French  translation. 

In  1807  Samuel  Hartman  d'Escher  submitted  to  the 
Faculty  of  Medicine  of  MontpelHer  a  thesis  upon  ovari- 
otomy containing  the  following  description: 

The  thesis  by  Sam.  Hartman  d'Escher  at  MontpelHer,  1807 
— "Considerations  medico-chinirgicals  sur  rhydropisie  enky- 
stee  des  ovaries,"  These  de  Montpellier,  1807 — contains  the 
following  description  of  the  operation  from  Thumin: 

"  Make  an  incision  along  the  outer  border  of  the  rectus 
muscle,  detach  with  the  fingers,  or  the  bistoury  even,  the  adhe- 
sions which  exist,  draw  out  and  excise  the  tumor  after  having 
tied  the  pedicle,  and  let  the  ligature  come  through  one  of  the 
angles  of  the  wound,  whose  edges  are  to  be  brought  together 
and  kept  coaptated  by  lateral  compresses  or  a  bandage  around 
the  body."  From  this  time  not  an  encouraging  word  has  ovari- 
otomy received  from  any  surgeon  in  France  for  more  than 
fifty  years,  or  up  to  the  year  1861.    {Peaslee.) 

If  we  are  correct  in  saying  that  incision  and  drainage, 
or  the  Houstoun  operation,  was  the  keynote  of  the  French 
school  before  the  time  of  McDowell,  we  are  equally 
correct  In  saying  that  opposition  to  extirpation,  or  the 
McDowell  operation,  was  the  keynote  after  his  time. 

176 


THE  OPPOSITION  OF  THE  EARLY  FRENCH  SCHOOL 

The  stubbornness  and  prejudice  that  marked  the  French 
attitude  can  only  be  appreciated  if  we  remember  that  up  to 
that  time,  the  close  of  1856,  the  operation  had  been  per- 
formed ninety-seven  times,  with  fifty-four  successes,  in  the 
United  States;  one  hundred  and  twenty-three  times,  with 
seventy-one  recoveries,  in  England;  and  forty-seven  times 
in  Germany,  with  thirteen  recoveries;  and  still  it  was 
being  unmercifully  condemned  in  the  first  city  of  France. 

We  may  scrutinize  the  history  of  medicine  ever  so 
carefully,  but  we  shall  fail  to  find  a  similar  instance  in 
which  the  opposition  to  a  new  advance  equalled  the  oppo- 
sition to  the  adoption  of  ovariotomy  that  marked  the 
French  school  in  particular.  It  was  a  degree  of  stub- 
bornness and  bitterness  that  usually  attends  proposals  of 
a  radical  nature  only,  which  ovariotomy  at  that  time  meant 
to  even  a  far  greater  degree  than  its  opponents  had  the 
faintest  conception  of.  In  fact,  the  most  prominent  sur- 
geons of  France  acted  as  though  they  were  oblivious  to 
what  had  a  decade  before  been  twice  successfully  accom- 
plished in  their  own  country,  not  to  mention  the  ovari- 
otomies in  other  countries,  of  which  the  successes  alone  had 
by  this  time  almost  reached  the  number  of  one  hundred 
and  fifty. 

On  April  28,  1844,  Doctor  Woycikowski,  at  Quingez 
(Doubs),  an  obscure  general  practitioner,  successfully  per- 
formed an  ovariotomy.  He  found  the  patient,  who  be- 
lieved herself  pregnant,  suffering  from  ascites,  and  tapped 
her.  This  enabled  him  to  perceive  a  movable  tumor  at 
the  pelvic  brim,  which  at  her  solicitation  he  removed. 
The  tumor  was  a  solid  one  weighing  six  and  one-half 
pounds,  and  had  the  fimbriated  extremity  of  the  Fallopian 
tube  adhering  to  it. 

Four  months  after  her  recovery  she  became  pregnant 
and  was  delivered  at  full  term  of  a  healthy  boy.    She  was 

12  177 


EPHRAiM  McDowell 

confined  a  second  time  in  December,  1846.  This  is  the 
first  recorded  ovariotomy  that  was  performed  in  France. 
On  September  15,  1847,  and  again  remote  from  Paris, 
at  Conde-sur-Noireau  (Calvados),  a  provincial  doctor, 
Doctor  Vaullegeard,  performed  another  ovariotomy,  which 
was  also  successful.  In  his  report  he  strikingly  outlined 
the  steps  to  be  followed,  viz: 

Open  the  abdomen,  more  or  less  widely,  grasp  the  tumor, 
reduced  or  not  in  size  by  one  or  more  punctures;  then  separate 
it,  after  having  tied  the  pedicle. 

It  is  singular  and  well  worthy  of  emphasis  that, 
although  the  idea  of  extirpation  as  the  only  cure  for  ova- 
rian tumors  was  suggested  and  discussed  in  various  coun- 
tries for  a  century,  it  remained  for  a  relatively  obscure 
country  doctor  in  the  backwoods  of  a  young  and  newly 
developed  country  to  put  the  idea  into  execution.  And 
strange  to  say,  what  occurred  in  America  was  repeated  in 
England,  Germany,  France,  and  Italy,  namely,  it  was  some 
obscure,  or  relatively  obscure,  practitioner  in  these 
countries  who  was  the  first  to  adopt  the  idea  and  success- 
fully carry  out  the  procedure.  The  surgeons  of  note  in  these 
countries,  practically  to  a  man,  either  ignored  or  actively 
condemned  the  step.  It  was  only  after  their  more  humble 
and  unpretentious  colleagues  had  accepted  and  demon- 
strated the  entire  feasibility  of  the  procedure,  that  the  high 
and  learned  descended  from  their  disdainful  perch,  and  fol- 
lowed the  lead  of  the  lowlier  members  of  the  profession. 

In  1856,  C.  L.  Bernard  pointed  out  the  results  obtained 
abroad,  and  pleaded  in  vain  in  its  favor.  This  was  fol- 
lowed by  a  carefully  prepared  paper,  in  i860,  by  M.  Jules 
Worms,  a  distinguished  general  practitioner  of  Paris, 
together  with  another  about  the  same  time  by  Boinet, 

178 


THE  OPPOSITION  OF  THE  EARLY  FRENCH  SCHOOL 

but  it  was  not  until  November,  1861,  that  Nelaton  was 
sufficiently  moved  to  go  to  England  and  see  Baker 
Brown  operate.  Here  he  saw  a  hght,  and  on  his  return 
Nelaton  delivered  what  has  been  referred  to  as  a  sensa- 
tional lesson  in  the  Hopital  des  Cliniques.  This  was  the 
first  advocacy  of  the  operation  by  a  French  surgeon  in  a 
French  University,  and  from  this  time  on  the  tide  changed 
in  France. 

We  may  correctly  say  that  the  adoption  of  ovariotomy 
in  France  dates  from  this,  or  had  its  beginning  in  the 
early  sixties,  twenty  years  after  it  had  its  beginning  in 
England,  and  fully  a  half  a  century  after  McDowell's 
first  operation. 

Then  followed  Demarquay,  who  operated  unsuccess- 
fully in  1862,  in  the  presence  of  Nelaton  and  Trousseau. 
About  the  same  time  Koeberle,  of  Strassburg,  Pean,  of 
Paris,  and  others  began,  until  by  1867  one  hundred  and 
twenty-two  operations  had  been  performed  with  forty- 
nine  recoveries.     (JPozzi.) 

The  role  of  the  British  School,  in  connection  with 
ovariotomy,  is  such  a  peculiar  one,  and  is  surrounded  with 
such  confusion  and  misunderstanding  that  it  deserves  a 
detailed  consideration.  In  the  second  period  of  the  evolu- 
tion of  ovariotomy,  which  was  contemporaneous  with  the 
advent  of  anaesthesia,  and  which  marked  the  real  adoption 
of  the  operation,  the  British,  beginning  with  the  work  of 
Dr.  Charles  Clay  of  Manchester  in  1842,  rapidly  assumed 
a  position  of  the  first  importance.  They  not  only  to  a 
degree  overshadowed  America  itself,  but  they  became  the 
distinct  fountain-head  from  which  surgeons  through 
Europe,  and  even  America,  received  their  inspiration.  This 
work  was  not  alone  of  the  highest  importance  so  far  as 
the  second  period,  or  the  period  of  adoption,  is  concerned, 

but  it  maintained  its  importance  throughout  the  third 

179 


EPHRAiM  McDowell 

period,  or  the  period  of  perfection,  during  which  certain 
debatable  details  were  settled,  and  the  mortality  was 
steadily  reduced  until  the  operation  for  a  time  stood 
alone,  in  the  realm  of  surgery,  in  point  of  brilliancy 
and  importance. 

This  important  relationship  to  the  second  and  third 
period  in  the  evolution  of  ovariotomy,  naturally  gave 
rise  to  the  conclusion,  held  by  many,  that  the  same  im- 
portant relationship  that  existed  during  the  second  and 
third  period  prevailed  throughout  the  first,  a  view  that 
we  are  unable  to  endorse,  and  that  we  beHeve  will  hardly 
be  supported  by  facts.  For  this  reason  an  additional 
review  of  the  British  attitude  during  the  first,  or  formative 
period  of  ovariotomy,  is  of  more  than  passing  interest. 

In  this  review  we  begin  with  Houstoun's  case,  in  1701. 
Houstoun's  operation,  although  a  daring  step  for  that  time 
and  a  credit  to  its  author,  was  not  an  ovariotomy;  and, 
we  may  safely  add,  in  no  way  aided  or  influenced  those 
who  came  after  him  in  the  development  of  ovariotomy. 
It  was,  perhaps,  largely  responsible  for  the  debate  later 
on  in  France  in  favor  of  incision  and  drainage,  with  a  sub- 
sequent addition  of  irritants,  made  by  the  French  in  the 
hope  of  solving  the  problem  of  ovarian  tumors.  But 
even  the  French  with  all  of  their  enthusiasm  about  the 
idea  were  finally  compelled  to  abandon  it  absolutely. 
Being  but  an  isolated  instance  of  successfully  opening  the 
abdominal  cavity,  it  carried  with  it  no  more  influence 
than  that  which  had  attended  many  other  isolated  in- 
stances of  successfully  opening  the  abdominal  cavity  for 
various  procedures  before  the  time  of  Houstoun. 

It  was  here  that  McDowell's  wisdom  and  method 
stand  out  in  bold  contrast  to  the  pioneers  who  preceded 
him  in  courageously  opening  the  abdominal  cavity  for 
some  intra-abdominal  condition.    He  wisely  waited  until 

180 


THE  ROLE  OF  THE  BRITISH  SCHOOL 

he  had  repeated  his  experiment,  or  until  it  ceased  to  be 
an  experiment,  and  became  an  accompHshed  fact,  before 
pubhshing  his  report.  This  apart  from  ovariotomy  in  par- 
ticular, carried  with  it  the  lesson  that  the  abdomen  could 
under  proper  care  be  invaded  with  a  reasonable  degree  of 
safety,  and  on  this  lesson  was  founded  the  entire  range  of 
abdominal  surgery.  It  was  only  after  ovariotomy  had 
achieved  a  permanent  and  brilliant  record  that  the  fol- 
lowers of  McDowell  took  courage  and  began  to  branch 
out  in  other  directions  of  the  abdominal  cavity;  and,  there- 
fore, it  is  only  fair  that  McDowell's  title  should  be  changed 
from  that  of  Father  of  Ovariotomy  to  Father  of  Ovario- 
tomy and  Founder  of  Abdominal  Surgery. 

Furthermore,  Houstoun,  when  he  began  his  operation, 
evidently  had  no  clear  or  preconceived  idea  of  what  he 
intended  to  do.  He  began  with  a  trocar,  and  what  fol- 
lowed was  simply  a  gradual  enlargement  upon  the  trocar, 
or  the  idea  of  tapping,  until  he  had  an  opening  of  about 
five  inches.  As  pointed  out  by  Grieg  Smith,  the  incision 
was  an  afterthought. 

The  next  figure  of  importance  that  we  have  observed 
in  the  British  school  is  that  of  William  Hunter,  who  on 
October  31,  1757,  read  a  paper  entitled  "The  History  of 
an  Emphysema,"  before  a  society  of  physicians  in  London. 
This  paper,  in  addition  to  being  a  report  of  a  case  of 
emphysema,  as  his  title  indicates,  also  covers  in  a  general 
way  the  realm  of  surgical  pathology  about  as  it  existed 
at  that  time,  and  lastly  according  to  his  particular  point 
of  view. 

From  this  paper  Sir  Spencer  Wells  has  taken  the 
extract  to  support  his  statement  of  the  credit  due  "a 
series  of  eminent  British  surgeons."  As  presented  by 
Sir  Spencer  Wells,  it  so  inadequately  represents  William 
Hunter's  views  that  we  deem  it  proper  to  reproduce  the 

181 


EPHRAiM  McDowell 

entire  section.  That  part  of  William  Hunter's  paper 
covering  his  views  upon  pathology  is  divided  into  sections, 
of  which  the  ninth  deals  entirely  with  his  remarks  upon 
"ovarian  dropsy"  and  the  proposed  measures  for  their 
relief,  to-wit: 

The  History  of  an  Emphysema,  by  William  Hunter,  M.D., 
Read  October  31,  1757.  Med.  Observations  and  In- 
quiries, London,  1762,  vol.  H. 

Section  IX.  The  encysted  dropsy  of  the  ovarium  is  a  case 
which  has  a  less  chance  still  of  being  carried  off  by  scarifications 
in  the  legs,  when  complicated  with  an  anasarca.  Purging,  etc., 
does  still  less  towards  evacuating  the  waters  in  this  case,  whether 
fluid  or  glutinous,  than  in  the  common  ascites. 

I  have  had  occasion  to  see  ^  great  number  of  encysted 
dropsies,  many  of  them  treated  by  physicians  of  the  first  rank, 
and  yet  have  never  seen  one  cured;  nor  have  I  ever  known  one 
case  of  that  kind,  when  the  cyst  has  been  sensibly  diminished 
in  bulk  by  any  other  means  than  by  the  trocar.  If  I  may  form 
a  judgment  from  what  I  have  seen,  both  in  the  living  and  in  the 
dead  body,  I  should  believe  that  the  dropsy  of  the  ovarium  is 
an  incurable  disease;  and  that  a  patient  will  have  the  best 
chance  of  living  longest  under  it  who  does  the  least  to  get  rid 
of  it.  The  trocar  is  almost  the  only  palliative.  It  has  been 
proposed  indeed  by  modern  surgeons,  deservedly  of  the  first 
reputation,  to  attempt  a  radical  cure  by  incision  and  suppura- 
tion, or  by  the  excision  of  the  cyst.  I  am  of  the  opinion  that 
excision  can  hardly  be  attempted;  and  that  incision  and  suppu- 
ration will  be  found  by  experience  to  be  an  operation  that 
cannot  be  recommended,  but  under  very  particular  circum- 
stances. That  the  reader  may  see  what  this  opinion  is  founded 
upon,  I  will  give  a  concise  account  of  the  nature  of  the  dropsy 
of  the  ovarium,  as  it  has  appeared  to  me  in  a  number  of  cases, 
both  in  the  living  and  dead  body. 

It  is  generally  of  a  considerable  size,  as  big  as  a  pint  bottle 
for  example,  before  it  is  discovered;  for  the  patient  generally 
has  neither  bad  health  nor  pain  to  put  her  upon  an  early  inquiry; 
and  while  it  is  small  it  is  perceptible  only  in  particular  situa- 
tions.   At  first  it  is  commonly  situated  towards  one  side  in  the 

182 


THE  ROLE  OF  THE  BRITISH  SCHOOL 

lower  part  of  the  belly,  and  is  movable  under  the  hand;  then 
it  becomes  gradually  more  fixed,  more  extended  both  forwards 
and  upwards  in  the  belly,  and  more  painful  and  oppressive  to 
the  patient,  etc.  When  the  cyst  is  single,  and  extended  over  the 
whole  abdomen,  it  cannot  be  distinguished  by  the  feel,  from  a 
common  ascites;  till  then  it  can  hardly  be  said  to  resemble  the 
ascites.  When  there  are  a  number  of  cysts,  we  are  generally 
sensible  of  the  inequality  in  the  swelling,  from  first  to  last. 

In  the  dead  body,  upon  examination,  we  find  they  take 
their  origin  from  the  ovarian,  or  adjacent  parts,  at  the  ligamen- 
tum  uteri  latum.  Both  when  small,  and  when  so  large  as  to 
contain  several  quarts,  they  are  sometimes  detached  or  loose 
all  around,  except  just  at  their  origin;  but  more  commonly 
they  are  found  to  have  contracted  partial  and  irregular  adhesions 
to  the  neighboring  parts,  seldom  indeed  if  ever  to  the  floating 
loose  turns  of  the  bowels.  When  they  are  come  near  to  their 
utmost  extension,  they  sometimes  adhere  uniformly  and  uni- 
versally to  the  parietes  of  the  abdomen;  but  more  generally,  even 
in  this  case,  the  adhesion  is  partial  and  irregular.  When  there 
is  only  one  cyst,  it  generally,  if  not  always,  contains  a  thin 
water:  when  there  are  many,  some  of  them  more  commonly 
contain  a  ropy  fluid,  in  consistence  like  gall  or  thin  honey;  and 
others  a  gelatinous  substance.  The  thin  water  is  usually  clear, 
the  ropy  fluid  of  a  dark  brown  color,  and  the  jelly  sometimes 
less  clear  and  transparent  than  the  white  of  an  egg:  sometimes 
it  is  mixed  with  opaque  white  parts:  sometimes  it  is  of  an  amber 
color;  and  at  other  times  dark  and  brown.  All  this  variety  has 
been  found  in  the  same  person.  I  can  hardly  say  that  I  have 
ever  found  any  part  of  a  dropsical  ovarium  in  a  truly  scirrhous 
state.  What  at  first  view  might  seem  such,  proved,  upon  cut- 
ting, to  be  a  compact  group  of  small  bags;  or  a  spongy  substance 
filled  with  jelly. 

Generally  before  the  patient  dies  of  such  a  dropsy  some 
degree  both  of  leucophlegmatia  and  of  ascites  is  brought  on:  so 
that  when  such  bodies  are  open  some  water  is  found  loose  in 
the  cavity  of  the  belly;  and  sometimes  the  cyst  is  found  to  have 
burst  and  to  have  discharged  its  contents  into  that  cavity. 

Now,  if  the  disease  be  nearly  what  I  have  stated,  must  not 
the  wound  made  in  the  belly,  for  the  excision  of  the  cyst  or 
cysts,  always  be  large  enough  to  admit  the  surgeon's  whole 

183 


EPHRAiM  McDowell 

hand?  Must  It  not  be  often  a  good  deal  larger;  as  when  the 
tumor  is  large,  and  composed  of  a  number  of  bags  filled  with 
jelly?  Would  not  such  a  wound  be  attended  with  a  good  deal 
of  danger  from  itself?  Would  it  not  be  very  difficult  to  cut 
the  peduncle  or  root  of  the  tumor,  with  one  hand  only  intro- 
duced? Would  it  not  be  impossible  to  do  this,  where  the  adhe- 
sions proved  to  be  considerable?  Would  there  not  be  great 
danger  of  wounding  the  intestines?  If  any  considerable  branch 
of  the  spermatic  artery  should  be  open,  what  could  the  surgeon 
do  to  stop  the  bleeding?  If  it  be  proposed  indeed  to  make  such 
a  wound  in  the  belly  as  will  admit  only  two  fingers  or  so,  and 
then  to  tap  the  bag,  and  draw  it  out,  so  as  to  bring  its  root  or 
peduncle  close  to  the  wound  of  the  belly,  that  the  surgeon  may 
cut  it  without  introducing  his  hand;  surely,  in  a  case  otherwise 
so  desperate,  it  might  be  advisable  to  do  it,  could  we  before- 
hand know  that  the  circumstances  would  admit  of  such  treatment. 
With  regard  to  incision  and  suppuration,  all  that  is  pro- 
posed to  be  got  by  this  painful  operation  is  the  change  of  the 
dropsy  into  an  incurable  fistulce  in  the  belly.  For  this  the  patient 
must  not  only  undergo  much  pain,  but  likewise  be  exposed  to 
great  danger;  particularly  where  the  cyst  happens  not  to  adhere 
to  the  muscles  at  the  part  where  the  incision  is  made,  or  where 
there  are  a  number  of  cysts.  In  the  first  case,  the  wound  would 
be  a  large  one,  communicating  with  the  cavity  of  the  abdomen; 
and  both  the  external  air  and  the  contents  of  the  incised  cyst 
will  be  admitted  into  that  cavity;  so  that  we  may  expect  very 
considerable  inflammation.  In  the  second  case,  where  there 
are  a  number  of  cysts,  the  inflammation  and  suppuration  will 
either  be  too  slight  to  discharge  all  of  them  or  too  considerable 
to  be  supported  with  life. 

It  was  a  common  belief  in  that  period,  and  for  some- 
time thereafter,  that  a  relationship  existed  between 
ascites,  anasarca  and  dropsical  ovaria,  as  ovarian  tumors 
were  called.  The  ovarian  tumor  was  in  short  an  encysted 
dropsy  of  the  ovary.  This,  therefore,  led  to  tapping 
alone,  or  to  tapping  and  the  injection  of  irritants. 

From  the  views  conveyed  in  section  nine  we  cannot 
escape  the  belief  that  William  Hunter  was  not  only  very 

184 


THE  ROLE  OF  THE  BRITISH  SCHOOL 

pessimistic  upon  the  subject,  but  that  his  remarks  upon 
the  surgical  treatment  of  ovarian  tumors  are  practically 
hopeless  in  their  tone.  This  very  discouraging  attitude 
of  Hunter's  goes  far  towards  explaining  why  so  little 
interest  was  manifested  upon  the  subject  in  Great  Britain 
following  Hunter's  time. 

We  were  surprised  to  have  discovered  upon  several 
occasions  references  expressing  astonishment  that  no 
action  followed  the  publication  of  William  Hunter's  views. 

From  such  a  discouraging  expose,  we  are  astonished 
that  ajiyone  should  expect  any  action  to  follow  so  hopeless 
a  summary,  made  by  one  of  the  recognised  leaders  in 
Great  Britain. 

How  could  anyone  find  anything  in  WilHam  Hunter's 
views  to  inspire  action,  and  what  more  could  be  said  than 
that  which  was  said,  to  intimidate  action? 

How  could  you  make  such  a  statement  as: — 

If  I  may  form  a  judgment  from  what  I  have  seen,  both  in 
the  living  and  in  the  dead  body,  I  should  believe  that  the  dropsy 
of  the  ovarium  is  an  incurable  disease  and  that  a  patient  will 
have  the  best  chance  of  living  longest  under  it  who  does  the 
least  to  get  rid  of  it.    The  trocar  is  almost  the  only  palliative — 

any  more  emphatic,  or  more  discouraging?  Even  the 
extract  which  Sir  Spencer  Wells  has  seen  proper  to  use 
has  the  depressing  proviso  attached,  namely — "could  we 
beforehand  know  that  the  circumstances  would  permit 
such  treatment" — a  proviso  that  in  those  days  meant 
far  more  than  it  does  in  the  present  time. 

William  Hunter  displayed  a  clearer  knowledge  of  the 
pathology  of  these  tumors  than  that  which  existed  in 
that  period,  and  for  this  he  deserves  credit;  but  an  endea- 
vor to  attach  any  particular  merit  to  him  in  the  develop- 
ment of  the  operative  side  of  ovariotomy  is  wholly 
unsupported  by  facts. 

185 


EPHRAiM  McDowell 

John  Hunter,  his  brother,  spoke  directly  and  clearly 
to  the  point  in  a  lecture  upon  this  subject  delivered  in 
1785.  This  lecture  was  delivered  twenty-eight  years  after 
William  Hunter's  paper  on  Emphysema.  These  views 
upon  ovariotomy  had  been  expressed  by  others  before 
the  time  of  either  William  or  John  Hunter.  In  short, 
if  we  look  backward,  we  see  the  suggestion  timidly 
made  in  the  latter  part  of  the  seventeenth  century 
debated  with  slowly  increasing  confidence  and  making 
converts  throughout  the  eighteenth  century,  and  put  into 
effect  in  the  early  part  of  the  nineteenth  century  through 
the  courage  of  one  who  was  really  nothing  more  than  an 
exceptionally  capable  country  doctor,  located  on  the 
frontier  of  a  new  country. 

It  was  carried  out  not  through  the  inspiration  of  any 
particular  person,  but  as  a  culmination  of  a  movement 
that  had  extended  over  a  period  of  at  least  a  century 
and  a  quarter. 

Theden,  before  the  time  of  the  Bells  and  the  Hunters, 
devised  an  operation  dealing  with  this  condition.  Samuel 
Hartman  d'Escher,  a  student  at  Montpellier,  described 
in  his  thesis  of  1807  practically  the  steps  which  McDowell 
had  employed,  with  the  exception  of  evacuating  the  con- 
tents before  delivering  the  sac;  and  McDowell  evacuated 
the  sac  only  after  he  realized  that  it  was  too  large  to  be 
delivered  without  evacuation.  Therefore,  we  feel  that 
both  of  the  Hunters  and  even  John  Bell  added,  aside 
from  their  approval,  nothing  special  to  the  develop- 
ment of  ovariotomy.  The  opinions  of  each  carried 
considerable  weight,  and  this  was  thrown  upon  the 
side  of  interference  through  extirpation.  The  idea,  how- 
ever, began  in  a  limited  and  timid  way  a  century  before, 
and  became  emboldened  and  developed  throughout  the 
century.     When  it  reached  the  Hunters  and  John  Bell, 

186 


THE  ROLE  OF  THE  BRITISH  SCHOOL 

it  had  acquired  its  full  maturity,  and  was  begging  for  some 
courageous  soul  to  put  it  into  execution.  To  conclude 
that  John  Bell  had,  through  any  special  remarks  upon  the 
subject,  made  a  special  impression  upon  McDowell,  or 
that  McDowell  had,  because  of  any  special  influence  of 
Bell's,  then  acquired  any  fixed  future  intentions  upon  the 
subject  is  nothing  short  of  the  wildest  conjecture. 

McDowell  in  all  probability  acquired  a  clear  working 
basis  upon  the  subject,  as  by  that  time  it  had  reached  a 
reasonably  settled  state,  not  owing  to  the  efforts  of  any 
particular  man  or  the  united  efforts  of  any  particular 
country,  but  through  a  gradual  and  studied  evolution 
extending  through  several  countries  and  covering  the 
space  of  over  a  century. 

The  paramount  question  is:  Who  was  the  first  to  pos- 
sess the  necessary  courage  to  put  this  into  execution  ? 

After  the  time  of  John  Hunter  and  John  Bell,  we  do 
not  encounter  anything  further  in  the  English  school 
until  we  come  to  John  Lizars.  This  covers  a  period  of 
practically  a  third  of  a  century,  or  from  1793,  when 
McDowell  attended  Bell's  lectures,  to  1824,  when  Lizars 
published  McDowell's  paper,  and  reported  his  own 
first  case,  which  proved  to  be  not  an  ovariotomy  but  a 
mistaken  diagnosis. 

To  the  extended  remarks  upon  Lizars,  and  the  full 
reproduction  of  his  paper,  there  remains  but  little  to  be 
added.  Lizars  first  attempted  ovariotomy  in  October, 
1823.  This  attempt,  which  proved  to  be  a  mistaken  diag- 
nosis, was  published  a  year  later  in  the  Edinburgh  Medical 
and  Surgical  Journal,  of  October,  1824.  This  was  his 
first  publication  upon  the  subject,  and  in  this  paper  he 
incorporated,  in  a  perfectly  matter-of-fact  manner,  the 
contribution  which  McDowell  had  sent  to  Bell  seven 
years  before. 

187 


EPHRAiM  McDowell 

It  is  worthy  of  emphasis  that  Dr.  Nathan  Smith,  of 
New  Haven,  who  was  the  second  ovariotomist  in  the 
United  States  and  the  third  in  the  world,  as  Chrysmar,  of 
Isny,  preceded  him  with  a  successful  case  by  one  year, 
also  published  his  case  in  the  Edinburgh  Medical  and  Surgi- 
cal Journal  of  October,  1822.  The  method  and  dates  of 
Nathan  Smith's  publication  are  of  more  than  passing 
interest.  In  his  method  he  followed  the  course  of  Mc- 
Dowell, though  possibly  not  consciously  so,  in  publishing 
his  successful  case,  as  nearly  as  possible,  simultaneously 
on  this  and  the  other  side  of  the  Atlantic.  It  appeared 
in  the  American  Medical  Recorder,  Vol.  V,  and  in  the 
same  year  in  the  Edinburgh  Medical  and  Surgical  Journal 
of  October,  1822. 

As  to  what  prompted  Lizars  to  attempt  the  operation, 
and  finally  to  publish  McDowell's  paper  after  it  had  so 
long  remained  in  his  possession,  even  after  John  Bell's 
death,  has  remained  more  or  less  of  a  mystery.  Circum- 
stantially, it  is  more  than  likely  that  the  solution  of  this 
mystery  lies  in  the  publication  of  Nathan  Smith's  case. 
When  Lizars  in  the  absence  of  John  Bell  received  Mc- 
Dowell's communication,  he  very  probably  attached  no 
more  importance  to  it  than  Physick  did  upon  this  side 
of  the  Atlantic.  To  those  situated  as  Lizars  and  Physick 
were,  on  the  summit  of  the  crest,  it  was  not  unusual  to 
view  the  pretentions  of  one  like  McDowell  with  amuse- 
ment and  distrust. 

The  reverence  in  which  the  peritoneum  was  at  that 
time  held,  a  respect  that  brought  forth,  among  others, 
comments  alike  from  the  editor  oi  th^  Edinburgh  Medical 
and  Surgical  Journal,  and  McDowell,  was  in  itself  quite 
enough  to  condemn  McDowell's  thrice  successful  efforts 
as  mere  fiction.  When,  however,  a  second  communica- 
tion in  the  shape  of  Nathan  Smith's  article  came  to  the 

188 


THE  ROLE  OF  THE  BRITISH  SCHOOL 

attention  of  Lizars,  he  very  likely  began  taking  notice; 
and  possibly  it  then  occurred  to  him  that  McDowell's 
communication  after  all  represented  something  more  than 
the  obsessions  of  a  madman  from  the  wilds  of  a  new  country. 

Smith's  article  may  have  possessed  an  added  interest 
in  coming  from  a  professor  of  surgery  in  one  of  the  first 
universities  in  this  new  country,  instead  of  from  a  back- 
woodsman; and  in  corroborating  the  work  of  McDowell, 
it  succeeded  where  McDowell's  communication  had 
failed.  If  all  this  is  true,  and  it  seems  both  reasonable 
and  logical,  the  case  of  Nathan  Smith  and  its  publication 
receive  a  new  and  decidedly  important  historical  signifi- 
cance. It  would  mean  that,  after  all,  the  awakening  of 
the  profession  came  through  Smith's  article,  as  McDowell's 
communication  was  nothing  more  than  an  unheeded  voice 
in  the  desert. 

This  would  be  in  harmony  with  the  usual  order  of  such 
events,  in  which  the  first  proposal,  or  the  performance  of 
the  originator,  is  rejected  as  the  ravings  of  an  insane 
member,  and  that  of  the  second,  who  is  but  the  follower, 
is  accepted  as  the  work  of  a  genius.  It  therefore,  seems 
that,  after  McDowell's  failure  to  arouse  interest,  came 
Smith's  article,  which  encouraged  and  inspired  Lizars 
to  action,  and  to  the  preparation  of  the  report  in 
which  he  incorporated  McDowell's  paper.  This  report 
attracted  the  attention  of  Doctor  Johnson,  whose  ire  be- 
came aroused,  and  who  in  consequence  thereof  made  noise 
enough  in  his  denunciations  of  McDowell  to  awaken  the 
slumbering  on  both  sides  of  the  Atlantic. 

In  1825,  the  year  after  Lizars  published  his  first  at- 
tempt, which  was  made  on  October  23,  1823,  he  operated 
three  times  in  the  three  consecutive  months,  February, 
March,  and  April.  The  first  of  these  three  operations  in 
1825  was  performed  on  February  27,  and  was  a  complete 

189 


EPHRAiM  McDowell 

and  successful  operation.  The  second  was  on  March  22. 
This  also  was  a  completed  operation,  i.e.,  the  tumor  was 
removed  but  the  case  ended  fatally  from  peritonitis  in 
fifty-three  hours.  The  third  was  on  April  24,  and  this 
was  an  incomplete  operation,  i.e.,  the  tumor  was  not 
removed,  but  the  patient  recovered  from  the  attempt. 
As  a  summary  of  Lizars'  ovarian  surgery,  we  have  one 
attempt  in  1823,  which  proved  to  be  a  mistaken  diagnosis, 
as  no  tumor  existed,  and  three  operations  in  1825.  In 
two  of  these  the  tumors  were  removed,  one  successfully 
the  other  unsuccessfully.  In  the  last  and  fourth  of  his 
cases,  the  operation  was  incomplete,  owing  to  adhesions. 
This  case  also  recovered.  The  operation  was  then  dis- 
continued in  Scotland  for  twenty  years,  when  Doctor 
Handyside,  of  Edinburgh,  operated  on  September  5, 1845. 
In  speaking  of  John  Lizars'  first  case,  the  editor  of 
the  Edinburgh  Medical  and  Surgical  Journal  remarks : 

Though  the  object  of  the  operation  was  not  attained,  its 
practicability  in  proper  cases  was  demonstrated,  and  the 
safety  of  laying  open  the  abdominal  cavity,  and  handling  the 
viscera  with  freedom  made  manifest,  contrary  to  the  doctrines 
of  the  schools. 

This  exhibition  of  nationalism  on  the  part  of  the  editor 
is  astonishing.  He  entirely  overlooks  the  fact  that  Dr. 
Nathan  Smith  had  two  years  before  published  his  success- 
ful case  in  this  very  journal,  and  that  two  years  after 
Smith's  publication,  when  Lizars  published  in  this  same 
journal  his  first  case  of  supposed  ovariotomy,  he  incor- 
porated McDowell's  first  three  cases,  which  had  appeared 
several  years  before  in  the  Eclectic  Repertory  and  Ana- 
lytical Review  in  America,  and  which  should  have  been 
pubHshed  in  Scotland  about  the  same  time  that  they 
were  in  the  United  States. 

Why  go  to  such  pains  to  credit  Lizars'  work  with  a 

190 


THE  ROLE  OF  THE  BRITISH  SCHOOL 

lesson  that  had  already  been  taught  by  McDowell  in  three 
successful  cases  published  seven  years  before,  and  verified 
by  Dr.  Nathan  Smith  in  another  successful  case,  reported 
two  years  before  Lizars  published  his  case,  thus  making  a 
record  of  four  successful  cases  performed  prior  to  Lizars' 
attempt,  all  of  which  appeared  in  the  Edinburgh  Medical 
and  Surgical  Journal  ? 

History  abounds  in  isolated  instances  in  which  the 
abdomen  was  successfully  opened  many  years  before  the 
time  of  McDowell.  That  the  possibility  of  successfully 
opening  the  abdominal  cavity  did  not  escape  observation 
is  attested  to  by  the  references  in  literature  long  before 
the  period  of  McDowell,  and  no  doubt  they  had  their 
influence  upon  the  development  of  ovariotomy.  But  as 
pointed  out,  these  cases  lost  their  importance  largely 
through  being  but  single  isolated  instances.  It  was  the 
thrice  repeated  performance  of  McDowell  that  placed 
his  work  beyond  the  possibility  of  its  being  a  chance,  but 
fortunate,  surgical  exploit.  Therefore  in  view  of  the  fore- 
going we  see  no  basis  for  the  belief  expressed  by  Sir  Spen- 
cer Wells  that  a  still  greater  credit  is  due  a  series  of 
eminent  British  surgeons,"  a  statement  unsupported  by 
facts,  and  distinctly  detracting  from  the  well-earned  and 
richly  deserved  honors  of  McDowell.  In  fact,  the  attitude 
of  not  only  the  eminent  British,  but  likewise  of  the  eminent 
American,  French,  and  German  surgeons  has  been  the 
same  towards  ovariotomy — namely,  to  ignore  it  as  long 
as  possible. 

What  stands  out  in  bold  rehef  in  the  history  of  this 
operation  is  that  it  represents  the  direct  and  individual 
efforts  of  a  country  doctor,  and  that  its  primary  adoption  in 
every  country  was  practically  due  to  men  of  the  same  char- 
acter as  McDowell — namely,  able,  courageous,  but  modest 
and  comparatively  unknown  members  of  their  profession. 

191 


EPHRAiM  McDowell 

The  three  milestones  in  the  British  relationship  to  the 
first,  or  developmental  period  of  ovariotomy,  are:  first, 
the  hopeless  pessimism  of  WiUiam  Hunter  in  his  paper  on 
Emphysema  in  the  year  of  1757;  second,  Dr.  James  John- 
son's unmerciful  criticism  of  McDowell  in  the  Lon. 
Medico-Chirurgical  Review  of  January,  1825,  and  October, 
1826;  and  third,  the  distrustful  indifference  of  John 
Lizars,  who  possessed  McDowell's  first  report  for  seven 
years  without  either  publishing  it  or  showing  that  it  had 
made  any  impression  whatever  upon  him  during  these 
seven  years  of  possession. 

Lizars  may  have  felt  a  proper  hesitancy  in  publishing 
a  paper  addressed  to  another  during  the  addressee's  life- 
time, but  John  Bell  died  on  April  15,  1820,  and  with  his 
passing  Lizars  was  no  longer  justified  in  withholding  from 
the  profession  a  paper  so  revolutionary  in  its  character. 
Instead  of  giving  it  to  the  world,  with  an  introductory 
explanation,  he  let  it  remain  buried  for  four  years  longer 
before  it  saw  light.  But  if  he  hesitated  in  its  publication, 
there  could  be  no  other  reason  than  that  of  distrust,  for 
he  was  not  enlightened  by  its  lessons,  although  his  access 
thereto  was  a  perfectly  proper  one. 

John  Lizars  was  also  a  pupil  of  John  Bell.  Among 
Lizars'  pupils  we  find  Dr.  Charles  Clay  of  Manchester, 
whose  first  operation  on  September  12,  1842,  marked  the 
beginning  of  the  British  activities  that  played  such  an 
important  role  in  the  second,  or  the  period  of  adoption, 
and  in  the  third,  or  the  period  of  perfection  of  ovariotomy. 
Lizars  was  born  in  1783,  received  his  license  to  prac- 
tice in  1808,  and  began  to  teach  anatomy  in  a  private 
school  in  181 5. 

In  183 1  he  became  Professor  of  Surgery  in  the  Royal 
College  of  Surgeons.  He  was  the  first  in  Scotland  to 
ligate  the  innominate  artery,  and  became  known  through 

192 


THE  ROLE  OF  THE  BRITISH  SCHOOL 

his  operation  for  neuralgia  of  the  inferior  maxillary  nerve, 
and  his  surgery  of  the  upper  and  lower  jaw. 

His  contributions  to  the  literature  upon  ovariotomy 
consisted  of  his  two  papers  in  the  Edinburgh  Medical  and 
Surgical  Journal  in  the  year  1824-25,  entitled  "Obser- 
vations on  Extirpation  of  Ovaria  with  Cases,  and  Obser- 
vations on  Extirpation  of  Diseased  Ovaria,  illustrated  by 
plates."  Among  his  published  works  are  "A  system  of 
Anatomical  Plates,  accompanied  with  Description  and 
Physiological,  Pathological  and  Surgical  Observations,"  in 
1822,  and  a  "System  of  Practical  Surgery,  illustrated," 
in  1838.  In  1839  he  ceased  teaching  and  devoted  himself 
to  private  practice.  He  was  a  skilled  anatomist  and  a 
brilliant  operator.    He  died  June  20,  i860. 

Although  twenty  years  elapsed  after  Lizars'  cases, 
published  in  1825,  before  ovariotomy  was  again  repeated 
in  Scotland,  it  was  attempted  in  London  for  the  first  time 
by  Dr.  A.  B.  Granville,  in  1826.  Granville's  name  was 
Augustus  Bozzi;  he  was  an  Italian  physician,  living  in 
London  as  Dr.  A.  B.  Granville.  (Ridenbaugh.)  Granville 
operated  twice.  His  first  operation  was  performed  on 
July  I,  1826,  but  owing  to  adhesions  it  was  abandoned, 
the  patient  recovering.  He  operated  the  second  time, 
March  21,  1827.  In  this  case  the  tumor,  which  is  said 
to  have  been  a  fibroid  of  the  uterus  weighing  eight 
pounds,  was  removed.  This  patient  died  seventy-two 
hours  after  the  operation. 

Following  these  two  cases  there  was  a  lapse  in  England 
until  1834,  when  Mr.  R.  C.  King,  of  Saxmundham,  Suffolk, 
did  his  successful  but  incomplete  operations  that  were  no 
more  than  explorations.  In  the  first  case  the  operation 
was  abandoned  at  the  request  of  the  patient.  The  case 
was  probably  that  of  a  malignancy,  the  patient  dying  a 
few  months  thereafter.  In  the  second,  which  was  per- 
formed in  March,  1834,  they  failed  to  find  the  tumor. 

13  193 


EPHRAiM  McDowell 

This  case  also  recovered  from  the  exploration.  In  his 
second  case  Mr.  William  JeafFreson,  acting  as  consultant, 
advised  the  operation,  and  was  present  at  its  performance. 
A  movable  tumor,  oval  in  form,  about  four  or  five  inches 
in  length,  and  occupying  the  right  side  was  made  out. 
At  the  operation  no  tumor  was  found,  but  the  right  kidney 
could  be  "handled  and  held  up  two  inches."  The  wound 
was  closed,  the  patient  making  a  speedy  recovery.  In  a 
further  report  two  or  three  years  later  she  was  enjoying 
better  health,  although  the  tumor  had  increased  to  one- 
fourth  or  one-third  its  former  size.  This  he  was  inclined 
to  attribute  to  the  relaxation  of  the  wall,  due  to  imperfect 
union.  The  incision  was  in  the  right  semilunar  line,  and 
most  likely  the  relaxation  he  refers  to  represented  a  hernia. 
He  intimates  that  he  neglected  to  elevate  the  pelvis,  and 
thus  it  may  have  been  that  he  overlooked  the  tumor,  which 
may  have  "slipped  into  a  concealed  location  in  the  pelvis." 

As  Granville's  first  case  was  an  incomplete  operation, 
and  his  second  a  fibroid  tumor  of  the  uterus,  the  credit 
of  being  the  first  to  have  successfully  performed  an  ovari- 
otomy in  England  is  due  Mr.  William  JeafFreson,  of 
Framlingham.  This  operation  was  performed  May  8, 
1836.  He  was  assisted  in  this  by  Mr.  King;  in  short, 
they  seemed  to  have  been  co-workers,  in  a  way,  so  far  as 
their  ovarian  cases  were  concerned. 

He  spoke  of  having  encountered  about  twenty  cases 
of  dropsical  ovaria  during  an  experience  extending  over 
thirty  years.  In  one  of  these,  occurring  but  a  short  time 
before  his  operation,  the  patient,  whose  ovarian  tumor 
was  complicated  with  pregnancy,  died  a  few  days  after 
delivery.  In  the  autopsy  upon  this  case  Mr.  JeafFreson 
studied  the  conditions  as  they  exist  in  such  cases,  and 
rehearsed  the  steps  to  be  followed,  thus  preparing  himself 
for  the  operation. 

194 


THE  ROLE  OF  THE  BRITISH  SCHOOL 

When  the  occasion  arose,  he  translated  his  obser- 
vations, made  at  the  autopsy,  to  the  operating  table; 
this  proved  to  be  the  first  successful  ovariotomy  in  Eng- 
land. The  steps  he  determined  upon  at  the  autopsy,  and 
which  he  followed  in  his  operation,  were  a  short  incision 
of  about  one  inch  midway  between  the  umbilicus  and 
pubes,  exposure  and  puncture  of  cysts  followed  by  the 
puncture  of  any  additional  cysts  that  presented  them- 
selves, delivery  of  the  sac,  ligation  of  the  pedicle  with  the 
ligature  cut  short  and  the  closure  of  the  wound. 

The  after-treatment  was  to  consist  of  large  doses  of 
"opium  with  foxglove"  and  "napkins  rung  out  of  the 
coldest  spring  water  constantly  applied  over  the  whole 
of  the  abdomen." 

In  applying  this  treatment  in  another  case  of  Mr. 
King's,  in  which  Mr.  JeafFreson  was  also  associated,  they 
gave  the  patient  immediately  after  the  operation  two 
drams  of  tincture  of  foxglove,  and  one  of  laudanum,  and 
locally  applied  cloths  wrung  out  of  ice  water,  frequently 
renewed,  to  the  entire  abdomen.    This  case  also  recovered. 

They  realized  in  this  case  that  the  short  incision  was 
not  only  inadequate,  but  dangerous,  since  the  ligature 
applied  en  masse  slipped,  and  the  sac  could  not  be  delivered 
until  they  had  enlarged  the  incision.  They  both  had 
decided  confidence  in  the  use  of  cold,  and  of  large  doses 
of  foxglove  in  "arresting  the  march  of  the  destroying 
power  of  inflammatory  disease,  acute  or  chronic." 

Following  Messrs.  Jeaff"reson  and  King  came  Mr.  W. 
J.  West,  of  Tunbridge  Wells,  with  a  successful  case.  In  the 
publication  of  his  report  Mr.  Wells  refers  to  the  work  of 
JeafFreson  and  King,  and  to  the  objections  made  by  the 
London  University  Medical  Society  to  JeafFreson's  report. 
These  were:  "first,  inapplicability  of  the  procedure  when 
adhesions  had  formed;  second,  the  danger  of  peritonitis; 

195 


EPHRAiM  McDowell 

third, when  the  cysts  are  numerous;  and  fourth,  the  disease 
being  compHcated  with  other  tumors." 

This  is  but  an  additional  instance,  illustrating  the  pro- 
gressiveness  of  the  provincial  English  surgeons  in  contrast 
to  the  discouraging  conservatism  of  the  metropolitan 
English  surgeons.  It  supports  our  views,  contrary  to  the 
claims  of  others,  that  the  English  are  entitled  to  little  if 
any  credit  for  the  development  of  ovariotomy  in  its 
first  period. 

Mr.  West  performed  three  other  operations.  One  of 
these  was  completed  and  successful;  the  other  two  were 
successful  but  incomplete.  Owing  to  the  adhesions  the 
tumor  was  not  removed. 

About  this  time  Mr.  John  Gorham,  of  Tunbridge, 
Kent,  published  a  paper  in  The  Lancet,  1839-40,  vol.  i, 
entitled,  "Observations  on  the  Propriety  of  Extirpating 
the  Cyst  in  Some  Cases  of  Ovarian  Dropsy,"  in  which  he 
reported  Mr.  West's  additional  cases  as  well  as  those  of 
Hargraves,  Jeaffreson,  Nathan  Smith,  and  the  one  per- 
formed in  Guy's  Hospital.  In  this  paper  he  commented 
upon  the  prior  proposal  of  William  Hunter,  in  connection 
with  the  short  incision. 

This  reference  brought  forth  a  protest  from  Mr. 
Jeaffreson  in  a  letter  to  the  editor  of  The  Lancet,  Nov.  2, 
1839,  in  which  he  said: 

I  beg  to  say  that  I  was  perfectly  sincere  in  claiming  the 
more  simple  mode  of  operating  In  these  cases  as  a  suggestion 
of  my  own  mind,  never  having  seen  or  heard  of  Doctor  Hunter's 
paper  on  the  subject.  Indeed,  I  think  that  It  is  the  deference 
which  has  been  paid  to  the  gigantic  authority  of  John  Hunter, 
more  particularly  to  his  theory  of  Continuous  Sympathy,  which 
has  kept  abdominal  surgery  in  comparative  abeyance. 

From  more  angles  than  one  the  above  quotation  is 
interesting.       Owing  to  the  importance  which  has  been 

196 


THE  ROLE  OF  THE  BRITISH  SCHOOL 

credited  to  the  influence  of  the  Hunters  in  the  develop- 
ment of  ovariotomy,  its  greatest  interest,  coming  as  it 
does  from  an  Englishman,  Hes  in  its  tendency  to  corrobor- 
ate the  expressed  opinion  of  the  error  of  Sir  Spencer 
Wells'  views. 

The  literature  of  this  period  abounds  in  the  expres- 
sions, the  "short  incision"  and  the  "longincision,"  which  in 
England  were  also  referred  to  as  the  minor  and  the  major 
operations.  It  was  but  one  of  the  many  doubtful  details 
that  were  debated  for  years,  after  the  time  of  McDowell. 

If  Mr.  Jeaffreson  was  the  first  to  operate  successfully 
in  England,  in  May,  1836,  Mr.  D.  H.  Walne  was  the  first  to 
operate  successfully  in  London,  on  November  6,  1842.  He 
was  not  the  first  to  operate,  as  both  A.  B.  Granville,  in  1826, 
and  Benjamin  PhiHps,  in  September,  1840,  preceded  him, 
but  he  was  the  first  to  perform  an  ovariotomy  successfully. 

Mr.  Walne's  operation,  it  seems,  was  not  performed 
in  a  London  Hospital;  a  successful  ovariatomy  in  a  London 
Hospital  did  not  occur  until  September  22,  1846,  or  more 
than  a  third  of  a  century  after  McDowell's  first  operation. 
The  operator  was  Mr.  Caesar  Hawkins. 

With  this  brief  recital  of  the  essential  features  of  the 
first  period,  we  come  to  the  second,  or  the  period  which 
marked  the  real  adoption  of  the  operation.  This  was 
coeval  with  the  introduction  of  anaesthesia,  on  which  its 
brilliant  success  was  mainly  dependent.  It  was  in  this, 
and  in  the  third  period,  that  the  British  bore  the  leading 
role  and  excelled  all  other  countries. 

More  intimately  identified  with  its  beginning  than  any 
other  operator  in  England  was  Dr.  Charles  Clay,  of 
Manchester.  He  began  his  career  in  ovarian  surgery  on 
September  12,  1842.  He  saved  three  out  of  the  first  four 
cases  he  operated  upon  in  that  year.  This  was  considered 
remarkable,  although  it  occurred  a  third  of  a  century  after 

197 


EPHRAiM  McDowell 

the  first  operation  of  McDowell,  who  a  third  of  a  century 
before  Clay  saved  four  out  of  his  first  five. 

By  March,  1863,  he  had  performed  one  hundred  and 
eight  operations  with  seventy  successes.  Doctor  Clay  was 
a  pupil  of  John  Lizars,  and  a  close  friend  of  Sir  James  Y. 
Simpson.  It  was  Simpson  who  suggested  to  Clay  the 
term  ovariotomy,  and  who  in  1846,  according  to  Tait, 
eloquently  defended  ovariotomy.  How  paradoxical  it 
seems  to  speak  of  the  "merit  due  eminent  British  Sur- 
geons," on  the  one  hand,  and  on  the  other  to  emphasize 
the  defense  of  the  procedure,  which  seemed  necessary  in 
England  nearly  four  decades  thereafter. 

Before  the  adoption  of  the  term  ovariotomy,  all 
abdominal  operations,  such  as  they  were,  passed  under 
the  generic  title  of  gastrotomy.  The  change  of  term 
was  suggested  in  1844. 

Peaslee,  in  referring  to  the  term  ovariotomy,  speaks  of 
it  as  "a  barbarous  compound  of  Latin  and  Greek,  which, 
besides,  does  not  express  the  meaning  intended.  It  means 
'cutting  an  ovary,'  or  Latin  ovario-section;  while  the 
term  used  should  signify  'cutting  out  an  ovary,'  or  Latin 
ovario-exsection.  From  all  analogy,  the  terms  should  be 
derived  from  the  Greek,  which  gives  oophorotomy,  ovary 
and  to  cut,  and  oophorectomy,  to  cut  out  the  ovary. 
Similar  terms  are  already  found  in  our  science,  as,  iridec- 
tomy, clitoridectomy,  etc."  Although  some  of  the  earher 
controversies  upon  the  priority  of  ovariotomy,  notably 
that  pertaining  to  Houstoun's  case,  resolved  themselves 
into  nothing  more  than  quibbles  over  the  meaning  of 
this  word,  inaccurate  as  it  is,  it  will  probably  survive  as 
a  vulgarism  in  the  scientific  vernacular,  based  upon 
usage,  which  is  usually  a  lasting  endorsement. 

After  Dr.  Clay  came  Sir  Spencer  Wells,  with  his 
exceptionally  brilliant  record. 

198 


THE  ROLE  OF  THE  BRITISH  SCHOOL 

Although  isolated  instances  were  recorded  before  the 
advent  of  ovariotomy  of  the  invasion  of  the  abdominal 
cavity,  the  occurrences  were  so  rare  that  the  impression 
came  into  existence,  about  the  time  of  McDowell,  that  an 
invasion  of  the  abdominal  cavity  meant  an  ovariotomy  or 
an  intended  ovariotomy.  This  was  due  to  the  fact  that 
ovariotomy  was  the  only  intra-abdominal  operation  that 
was  accorded  any  degree  of  recognition.  The  mere  in- 
vasion of  the  abdominal  cavity  was  so  exceptional  in  that 
period  that  we  meet  in  the  earlier  literature  with  such 
expressions  as  the  "first  operation"  or  the  "third  opera- 
tion," as  the  case  may  be,  which  meant  the  first  gastrot- 
omy,  or  as  we  would  say  to-day,  the  first  laparotomy  or 
abdominal  section. 

This  so-called  "first  gastrotomy,"  as  it  is  recorded  in 
the  early  literature,  may  mean  simply  an  exploration 
without  any  attempted  interference;  or  any  exploration 
with  attempted  interference  that  for  some  reason  was 
abandoned  before  the  Intended  step  was  accomplished, 
thus  making  what  has  been  called  an  "incomplete  opera- 
tion"; or,  lastly,  the  object  was  accomplished  and  the 
case  classed  as  a  completed  operation.  It  is,  therefore, 
essential,  in  order  to  avoid  being  misled,  to  consider  care- 
fully the  early  reports  in  order  that  the  proper  distinction 
be  maintained. 

If  in  the  present  day  we  are  at  times  In  doubt,  and 
therefore  explore,  or  if  we  feel  certain,  and  find  ourselves 
mistaken,  it  is  needless  to  add  that  the  same  occurred  in 
those  early  times;  and  a  study  of  the  incomplete  opera- 
tions of  that  period  reveals  a  number  of  cases  that  were 
malignant  and  would  have  been  as  Inoperable  to-day  as 
they  were  then.  Many  others  were  abandoned  because 
of  adhesions  that  would  have  been  surmounted  in  the 
surgery  of  the  present  day.    In  overcoming  adhesions  the 

199 


EPHRAiM  McDowell 

earlier  operators  were  at  a  distinct  disadvantage,  without 
the  aid  of  a  general  anaesthetic.  We  know  that  the 
handling  of  abdominal  or  pelvic  viscera  is  practically 
without  pain  until  we  begin  to  interfere  with  the  parietal 
peritoneum.  Therefore  at  that  time,  no  doubt,  some  of 
the  incomplete  operations  would  have  been  completed 
operations  if  the  operator  could  have  availed  himself 
of  the  benefits  of  a  general  anaesthesia.  In  short,  an 
extended  adoption  of  ovariotomy  was  simply  impossible 
without  the  assistance  of  anaesthesia. 

To  the  immediate  followers  of  McDowell,  we  owe  a  dis- 
tinct debt  of  gratitude,  second  only  to  McDowell  himself. 
To  the  bravery  and  persistence  of  these  men  who  kept 
the  light  burning,  and  who  advanced  the  colors  in  the 
struggle  for  the  establishment  of  the  operation,  too  much 
homage  cannot  be  paid.  We  have  endeavored  to  point 
out  the  stubbornness  and  bitterness  with  which  the  opera- 
tion was  assailed,  and  the  abuse  to  which  its  defenders 
were  subjected,  but  we  are  entirely  conscious  of  the 
inadequacy  of  our  efforts.  This  rancorous  struggle  con- 
tinued well  into  the  second  period,  even  after  the  opera- 
tion had  lost  much  of  its  terror,  through  the  beneficent 
influence  of  anaesthesia. 

The  brunt  of  this  struggle,  like  the  honor  of  its  incep- 
tion, fell  upon  America,  and  the  names  that  shine  with  a 
special  splendor  are  those  of  Nathan  Smith,  Alban  G. 
Smith,  known  as  Alban  Goldsmith,  David  Rogers,  J. 
BeUinger,  J.  A.  Gallup,  R.  D.  Mussey,  Doctor  Trowbridge, 
the  Atlees,  J.  L.  and  W.  L.  Kimball,  Dunlap,  and  others. 

It  would  be  an  injustice  to  the  other  side  of  the  Atlantic 
to  ignore  that  German  successor  of  McDowell  in  the  little 
Wiirtemberg  town  of  Isny,  who  in  1819,  two  years  after 
McDowell's  publication,  performed  an  ovariotomy;  and, 
although  the  patient  died,  his  confidence  and  his  courage 

200 


THE  ROLE  OF  THE  BRITISH  SCHOOL 

remained  unimpaired,  for  he  twice  repeated  the  perform- 
ance the  next  year,  with  one  success.  Whether  he  had 
seen  McDowell's  report  or  not,  his  efforts  are  well 
worthy  of  a  monument  by  his  countrymen,  and  with 
credit  he  can  take  his  place,  as  the  second  ovariotomist, 
on  the  right  hand  of  the  immortal  McDowell. 

Lastly,  in  reverence,  we  salute  the  capable,  courageous, 
but  obscure  practitioners  of  every  country  who  with 
commendable  clearness  of  idea  and  firmness  of  purpose 
adopted  the  procedure,  while  their  more  pretentious  col- 
leagues either  assumed  an  attitude  of  silent  distrust,  or 
in  frenzied  discussions  prophesied  disaster  with  the  implied 
admonition  that  always  marks  human  progress,  "not  to 
disturb  the  existing  order." 

With  the  second  period  of  the  operation,  which  began 
in  the  early  'forties  and  which  extended  well  into  the 
'seventies,  a  space  of  at  least  a  third  of  a  century,  the  oper- 
ators increased  in  number  and  their  results  correspondingly 
improved.  With  this  steady  increase  in  the  number  of 
operators,  and  this  steady  improvement  in  the  results,  the 
opposition  uniformly  diminished,  until  by  the  early  'seven- 
ties it  had  faded  away. 

During  this  period  many  ideas  were  advanced,  tried, 
and  accepted  or  rejected.  Prominent  among  these  were 
the  length  of  the  incision.  Some  favored  a  short  incision 
of  an  inch  or  two,  and  others  a  long  incision  that  freely 
exposed  the  pathology  involved.  Whether  the  ligature 
should  be  left  long  and  brought  out  of  the  lower  angle  of 
the  wound,  or  cut  short  and  dropped;  the  treatment  of 
the  pedicle,  and  the  adoption  and  method  of  drainage 
— these  and  other  but  lesser  details  were  tried  out  and 
settled  during  this  period.  But,  after  all  this  experimental 
phase  had  run  its  course,  they  returned  to  the  basic  prin- 
ciples as  practiced  by  McDowell  himself.     To-day  the 

201 


EPHRAiM  McDowell 

operation  is  as  he  gave  it  to  us,  with  nothing  added  but 
the  refinements  incident  to  modern  surgery. 

With  the  dread  and  mystery  removed,  to-day  we  make 
an  incision  as  large  as  is  necessary,  but  no  larger;  we 
ligate  our  pedicle  and  leave  it  to  nature;  we  drain  when 
necessary,  but  not  otherwise.  There  is  no  longer  a 
machine-like  exactness  to  the  operation  as  practiced  by 
this  or  that  operator;  each  case,  so  far  as  such  details  are 
concerned,  is  a  law  unto  itself,  and  every  operator  uses  his 
own  judgment. 

As  the  second  period  was  dependent  upon  the 
introduction  of  anaesthesia  by  the  Americans,  so  was  the 
third  period  dependent  upon  an  understanding  of  the 
principles  underlying  infection  through  the  labors  of  Sir 
Joseph  Lister.  With  Lister's  teaching,  which  began  in 
1 867-68,  but  was  some  years  in  bearing  fruit,  the  operation 
of  ovariotomy  received  its  final  impulse.  The  operators 
increased  in  number,  and  were  disseminated  over  wider 
parts  of  the  world.  Modern  surgery,  with  its  almost 
countless  safeguards,  in  time  became  developed  in  every 
detail.  With  these  advances,  the  operation  ceased  to  be 
the  exclusive  privilege  of  the  few.  It  was  adopted  by  the 
many,  until  it  is  now  practiced,  and  with  a  reasonable 
degree  of  safety,  in  every  civilized  community,  large  and 
small,  throughout  the  world. 

None  of  us,  however,  unless  previously  prepared 
through  an  investigation  of  the  subject,  can  realize  the 
painful  slowness  that  marked  the  adoption  of  this  opera- 
tion. From  McDowell's  simple  but  effective  and  success- 
ful ovariotomy,  to  the  present  complicated  status  of 
abdominal  surgery,  that  fairly  beggars  description,  is  a 
long,  painful,  and  laborious  journey.  But  of  all  the  ad- 
vancements, discoveries,  and  benefits  that  have  come 
within  human  observation,  scarcely  any  have  equalled, 

202 


THE  ROLE  OF  THE  BRITISH  SCHOOL 

and  none  has  excelled  the  importance  of  the  direct  and 
indirect  results  of  ovariotomy. 

We  now  realize  that  this  was  due  to  the  fact  that  it 
was  more  than  the  introduction  of  a  new  operation.  It 
meant  a  revolution  in  surgical  thought  and  practice,  from 
which  the  present  and  highly  developed  status  of  abdom- 
inal surgery  gradually  evolved.  Unless  we  keep  this  idea 
clearly  before  us,  we  shall  lose  the  real  import  of  the  life 
and  work  of  Ephraim  McDowell. 

Those  of  us,  who  are  accustomed  to  seeing  an  opera- 
tion proposed,  and  accepted,  or  rejected  within  a  year  or 
two,  can  hardly  realize  that  the  first  ovariotomy  in  France 
was  not  performed  until  1844,  and  that  it  was  1861,  or 
more  than  a  half  century  after  McDowell's  jfirst  venture 
before  a  favorable  word  was  said  for  it  by  a  French 
professor  in  a  French  University.  And  as  between  France 
and  Great  Britain,  the  difference  was  not  as  great  as 
many  of  us  believe.  Scotland  led  with  Lizars'  work  in 
1823,  which,  however,  was  not  an  ovariotomy.  In  1825  he 
succeeded,  but  after  that  no  further  effort  was  made 
for  twenty  years. 

In  England,  A.  B.  Granville  tried  his  luck  in  1826  and 
1827,  but  the  results  were  not  encouraging.  Then  Jeaffre- 
son,  a  provincial  English  surgeon,  came  forward  with  the 
first  successful  ovariotomy  in  England  in  1836.  But  the 
first  success  in  Londoh  did  not  occur  until  Walne's  case 
in  1840;  and  it  was  fully  1846  before  a  London  Hospital 
proper  could  boast  of  a  successful  ovariotomy.  It  was  over 
a  third  of  a  century  before  one  of  the  hospitals  in  the 
first  metropolis  of  the  world  succeeded  in  doing  what  an 
American  frontiersman,  practicing  without  a  diploma, 
had  several  times  successfully  carried  out. 


203 


CHAPTER  X 

THE    PERSONAL   SIDE    OF   DR.    EPHRAIM   McDOWELL 

With  this  brief  resume  of  the  development  and  prog- 
ress of  ovariotomy,  we  pass  to  the  more  personal  consider- 
ation of  this  pioneer  master  in  abdominal  surgery.  With 
the  appearance  of  his  first  report  came  his  earliest  public 
recognition.  In  1817,  the  Medical  Society  of  Philadelphia, 
one  of  the  most  distinguished  in  this  country,  publicly 
recognized  McDowell's  ability,  and  in  1825  he  received 
an  honorary  degree  from  the  University  of  Maryland. 
There  is  hardly  any  room  for  doubting  that  this  was  the 
first  degree  that  was  conferred  upon  him.  Lunsford  P. 
Yandell,  Sr,,  suggests  that  this  came  through  Dr.  John 
Beale  Davidge,  one  of  the  founders  of  the  University  of 
Maryland.  Davidge  was  a  friend  and  a  contemporary  of 
McDowell  at  the  University  of  Edinburgh.  Yandell's 
explanation  is  most  likely  the  correct  one. 

Up  to  that  time  McDowell  had  been  practicing  his 
profession  without  any  proof  of  his  fitness,  save  that 
supplied  through  the  services  which  he  so  conscien- 
tiously rendered. 

His  childhood  days  were  spent  in  the  vicinity  of 
Fairfield,  about  thirteen  miles  northeast  of  Lexington,  Vir- 
ginia. This  was  on  the  extreme  edge  of  Western  civili- 
zation, and  not  far  from  where  his  grandfather  fell  while 
defending  his  grant  against  the  Indians,  a  little  more  than 
a  quarter  of  a  century  before.  It  was  as  fertile  and 
picturesque  a  region  as  one  could  ordinarily  find,  and, 
had  it  not  been  for  the  Indian  troubles  that  marked  its 
past,  and  the  still  greater  troubles  of  the  impending 
revolution  that  threatened  its  future,  it  would  have  been 
restful  and  peaceful. 

204 


THE  PERSONAL  SIDE  OF  DR.  EPHRAIM  McDOWELL 

While  McDowell  was  still  in  his  infancy,  the  prelude 
to  the  struggle  that  was  destined  so  vitally  to  influence 
the  powers  of  the  universe  and  the  fate  of  humanity  was 
already  in  progress. 

In  1774  a  conflict  was  waged  on  the  Western  border 
between  the  Indians  and  the  Virginians.  According  to 
many,  this  was  nothing  more  than  an  attempt  to  involve 
the  Virginians  in  a  struggle  with  the  Indians,  and  thus 
divert  them  from  the  impending  Revolutionary  War. 
This  was  known  as  Dunmore's  War,  after  Lord  Dunmore, 
the  last  of  Virginia's  colonial  governors.  Indeed,  momen- 
tous events  were  brewing.  In  1776,  or  about  five  years 
after  McDowell's  birth,  the  Declaration  of  Independence 
was  promulgated  and  the  colonies  declared  themselves 
free  and  independent  states.  Although  his  childhood 
was  spent  in  what  ordinarily  was  a  quiet  Virginia  ham- 
let, it  is  obvious,  in  view  of  the  stirring  events,  that  his 
environment  was  not  so  peaceful  and  free  from  tension  as 
such  villages  ordinarily  are.  He  began  his  life  in  an  at- 
mosphere of  strife,  courageous  independence,  and  self- 
reliance,  and  doubtless  early  acquired  a  full  share  of 
those  sterhng  qualities  that  stood  him  in  such  good  stead 
in  the  historic  role  he  was  destined  to  enact.  McDowell 
has  so  often  been  referred  to  as  "a  frontiersman,"  "a  back- 
woodsman," and  the  like,  that  most  of  us  at  least  have 
unconsciously  formed  ideas  of  his  handicaps,  his  hard- 
ships and  lack  of  opportunity,  which  are  altogether 
erroneous  and  misleading.  If  it  is  true  that  he  was 
denied  the  advantages  that  a  large  city  and  more  modern 
times  off'er,  it  is  equally  true  that  he  was  also  spared  the 
disadvantages  that  are  inseparable  from  a  large  city, 
and  that  are  the  unavoidable  attendants  of  more 
modern  times. 

Instead  of  handicaps,  hardships,  and  lack  of  oppor- 

205 


EPHRAiM  McDowell 

tunity,  which  in  a  manner  did  exist,  in  reality,  if  properly 
considered,  the  opposite  more  accurately  represents 
his  status. 

From  his  birth  to  his  death  he  belonged  to  the  aris- 
tocracy of  his  time  and  place.  By  aristocracy  we  mean 
more  than  that  which  the  term  usually  implies.  It 
was  not  an  aristocracy  of  wealth  and  leisure,  it  was  more, 
it  represented  the  foremost  citizens  in  a  new  and  aggres- 
sive country.  Pretentiousness  was  notably  absent,  and 
in  its  place  were  the  simplicity,  independence,  and  self- 
reHance  of  the  truly  vigorous  frontier  people. 

Schools  in  the  present  acceptation  of  the  term  were 
nonexistent  during  his  childhood,  but  a  substitute  that 
was  even  better  did  exist.  In  the  absence  of  organized 
schools,  the  education  of  youth,  when  it  occurred,  became 
under  the  existing  arrangement  more  personal  and  pains- 
taking than  that  which  commonly  occurs  in  organized 
schools.  The  inhabitants  fell  into  two  classes,  the  aris- 
tocracy, and  the  poor  whites;  the  negroes  were  slaves. 
During  the  boyhood  of  McDowell's  father,  Archibald 
Alexander,  his  kinsman,  who  had  been  liberally  educated 
in  the  old  country,  took  charge  of  his  education  and 
that  of  the  youth  of  that  time  and  place.  Most  likely  a 
somewhat  similar  arrangement  existed  during  the  early 
years  of  his  son  Ephraim's  life,  through  which  his  pri- 
mary education  was  acquired. 

That  such  an  arrangement,  involving  as  it  did  a  per- 
sonal interest  in  the  pupil  and  the  moldingof  his  character, 
in  addition  to  the  mere  imparting  of  knowledge,  was 
superior  to  an  organized  school,  open  to  all,  is  self-evident. 
At  any  rate,  there  are  no  grounds  for  the  belief  that  his 
education  at  any  stage  was  in  the  least  neglected,  although 
it  was  different  from  the  conventional  ideas  of  the 
present  time. 

206 


THE  PERSONAL  SIDE  OF  DR.  EPHRAIM  McDOWELL 

In  1783,  on  the  eve  of  his  thirteenth  year,  he  was  taken 
to  his  future  home  in  Danville.  With  the  exception  of  a 
few  short  intervals,  it  was  here  that  he  spent  his  life, 
and  it  was  here  that  he  performed  those  deeds  that  were 
destined  to  endow  him  with  an  undying  fame. 

If  the  environment  of  his  childhood,  from  which  he 
had  just  taken  his  departure,  was  full  of  tension  as  the 
result  of  the  events  that  were  then  transpiring,  that  of 
his  boyhood  and  future  manhood  to  which  he  was  removed 
was  even  more  so.  The  reconstruction  days,  with  their 
attending  restlessness,  following  the  Revolution  were 
at  hand.  To  the  problems  incident  to  these  were  added 
the  unsettled  strife  with  the  Indians,  the  tangled  state 
of  the  land  claims,  with  their  attendant  disputes  and 
bitterness,  and  lastly  the  intrigues,  referred  to  in  a  former 
chapter,  upon  which  the  stability  of  the  newly  formed 
United  States  was  more  dependent  than  most  of  us  at 
the  present  time  have  the  faintest  idea  of.  That  the 
training  which  such  an  environment  afforded  was  in  itself 
a  liberal  education  and  of  the  greatest  advantage  is  unde- 
niable; and  that  its  influence  eminently  fitted  McDowell 
later  in  life  to  follow  his  convictions  wherever  they  led 
is  equally  plain. 

In  addition,  we  find  references  to  private  schools  in 
his  adopted  state,  and  an  academy  at  Lexington,  Virginia, 
which  he  may  have  attended,  and  which  may  have  served 
to  supply  an  ample  educational  foundation  for  the  career 
he  elected  to  follow.  His  medical  training,  although 
incomplete  if  judged  by  the  standards  of  to-day,  was  in 
fact  comparable  to  the  best  of  his  time,  even  though  he 
did  round  out  his  career  without  a  diploma. 

He  began  under  the  tutelage  of  Dr.  Alexander  Hum- 
phreys, who  was  a  graduate  of  the  University  of  Edin- 

207 


EPHRAiM  McDowell 

burgh,  and  the  most  respected  and  the  ablest  of  the 
practitioners  of  Staunton.  From  Staunton  he  went  to 
the  University  of  Edinburgh,  and  while  there  he  was  not 
content  with  what  the  University  offered,  so  he  entered 
the  private  class  of  John  Bell,  who  taught  outside  of  the 
University.  That  this  training  did  not  touch  an  unre- 
sponsive chord  is  evidenced  by  the  high  standards  that  pre- 
vailed throughout  his  professional  life.  The  emphasis 
that  both  his  preceptor  and  his  tutor,  John  Bell,  placed 
upon  systematic  dissecting  was  not  lost;  and  the  difficulties 
under  which  he  practiced  these  teachings  accentuate  more 
than  anything  else  the  ideals  that  governed  his  profes- 
sional career. 

Today  we  all  would  do  better  work  and  advance 
faster  if  we  gave  the  same  attention  to  dissections  that 
McDowell  is  said  to  have  given  in  his  day.  In  that  respect 
we  have  fallen  behind,  although  the  opportunities  for 
practicing  these  anatomical  studies  are  much  better  to-day 
than  they  were  during  his  time. 

His  attendance  at  the  University  of  Edinburgh  not 
only  added  the  advantages  which  one  of  the  first  Uni- 
versities of  the  world  easily  supplied,  but  his  sojourn  in 
Scotland  could  hardly  fail  in  broadening  his  outlook  on 
life,  and  in  giving  him  a  more  accurate  perspective  of 
America,  the  country  in  which  he  was  to  spend  the  re- 
mainder of  his  days.  Favored  with  such  distinct  advan- 
tages, and  located  as  he  was  on  the  frontier  of  civilization, 
virtually  without  competition,  strengthened  through  the 
influence  of  his  family,  it  was  not  long  before  he  acquired 
an  extensive  practice  covering  a  territory  extending  miles 
beyond  his  immediate  village. 

We  have  referred  in  detail  to  the  deep  interest  and 
sympathetic  kindness  that  characterized  his  services  to 
his  patients,  his  preference  for  operating  on  Sunday,  and 

208 


THE  PERSONAL  SIDE  OF  DR.  EPHRAIM  McDOWELL 

the  careful  rehearsal  of  his  role  and  those  of  his  assistants 
in  the  performance  of  any  prospective  operation.  His 
surgery  was  all  performed  before  the  era  of  anaesthesia, 
and  many  of  his  operations  occurred  miles  from  his  base, 
and  amid  many  and  varied  difficulties. 

It  was,  indeed,  a  great  training,  and  at  the  same  time  a 
severe  test  of  his  resourcefulness,  but  he  was  equal  to  the 
occasion,  and,  when  the  event  arose  upon  which  his  fame 
depended,  he  was  ready.  With  the  calmness,  firmness 
and  precision  that  marked  his  operations  in  general,  he 
proceeded  with  "the  experiment,"  as  he  expressed  it, 
that  in  time  meant  so  much  to  humanity,  and  that  revolu- 
tionized the  practice  of  surgery.  Notwithstanding  his 
enumerated  educational  advantages,  he  was  not  what  we 
would  today  call  a  highly  educated  or  scholarly  man, 
and  through  his  aversion  to  writing  and  the  absence  of 
notes,  he  not  only  stood  in  his  own  light,  but  we  all  have 
lost  some  of  the  best  and  most  interesting  features  of  his 
unique  professional  career. 

In  his  relations  to  his  immediate  professional  associates 
he  was  modest  and  generous  to  a  fault.  In  fact  his  modesty 
and  generosity  were  more  responsible  than  anything  else 
for  the  attempt  to  deprive  him  of  his  glory.  Because  he 
generously  and  graciously  permitted  his  nephew  and 
partner,  James  McDowell,  to  make  the  incision,  and 
thus  acquire  at  least  a  share  of  reflected  glory,  the  fact 
was  seized  upon  by  others  who  endeavored  to  make  it 
appear  that  this  beneficiary  was  the  real  hero,  and  the 
only  one  who  was  entitled  to  any  credit. 

The  treatment  he  accorded  his  colleagues,  however, 
was  quite  unlike  that  which  he  received  from  them. 
Those  unfortunate  qualities  which  seem  inseparable  from 
human  nature,  yet  which  are  so  discreditable  to  it,  he 
was  made  to  feel  throughout  his  professional  career. 

14  209 


EPHRAiM  McDowell 

Some  of  his  competitors,  in  effect,  craftily  spread  the 
impression  that  when  it  came  to  surgery  he  could  be  relied 
upon,  but  that  **he  was  not  much  in  fevers."  The  animus 
of  this  we  can  only  appreciate  if  we  remember  the  com- 
parative relationship  that  then  existed  between  surgery 
and  internal  medicine.  That  he  distinctly  favored  surgery 
has  always  been  undeniable,  but  that  this  predilection 
should  have  detracted  from  his  ability  to  treat  fevers  as 
they  were  treated  in  his  time  is  so  ridiculous  that  it  de- 
serves to  be  mentioned  only  in  order  to  add  some  of  the 
local  color  of  his  time.  It  was  the  same  story  then  as  it  is 
today,  and  always  to  the  discredit  of  the  profession — not 
that  there  is  any  especial  element  of  meanness  in  our 
profession;  it  is  due  rather  to  the  nature  of  our  work,  which, 
unfortunately,  does  not  tend  to  as  broad  a  mental  horizon 
or  to  as  liberal  an  interpretation  of  life  as  we  should  like 
to  see. 

This  treatment  did  not  stop  here,  but  grew  to  such 
proportions  as  to  become  a  distinct  calumny,  involving 
his  family  as  well  as  himself.  The  fighting  of  a  revolu- 
tionary war,  the  conflicts  with  the  Indians,  and,  lastly, 
the  wrangles  over  land  claims  developed  some  savage 
tendencies  that  were  not  always  kept  in  proper  restraint. 
The  slanderous  references  were  the  basis  of  a  paper 
by  Dr.  J.  P.  McChesney,  and  were  also  favored  with  a 
notice  by  McDowell's  granddaughter,  Mary  Young  Riden- 
baugh.  Fortunately  this  Hbellous  element  represented  the 
exception,  and  it  only  shows  that,  however  respected  he 
was,  and  however  influential  his  family  was,  he  did  not 
escape  the  petty  thrusts  so  common  to  humanity. 

McDowell  was  never  associated  with  a  medical  college. 
From  the  standpoint  of  the  institution  it  was  a  great 
mistake  for  the  Transylvania  University  to  have  over- 
looked McDowell  as  a  possible  member  of  its  faculty. 

210 


THE  PERSONAL  SIDE  OF  DR.  EPHRAIM  McDOWELL 

The  reason  for  this  has  never  been  satisfactorily  cleared 
up.  It  may  have  been  due  to  McDowell's  indifference  to 
any  step  or  practice  that  brought  him  prominently 
before  the  pubHc  or  before  his  profession.  Likewise  he 
has  been  credited  with  possessing  an  undue  amount  of 
diffidence,  which  also  may  be  the  explanation.  The  fact 
that  he  was  an  exception  to  his  companions  at  Edinburgh 
in  not  associating  himself  with  others  in  the  founding  of  a 
medical  school  somewhat  supports  this  view.  Hosack, 
Davidge  and  Brown  seem  to  have  determined  upon  this 
step  during  their  University  days;  at  least  on  their  return 
they  were  quickly  absorbed  in  the  organization  of  a 
medical  college. 

But  this  neglect  may  also  have  been  part  of  the  tend- 
ency that  was  in  existence  at  that  time  to  underrate  the 
man  and  his  ability.  So  far  as  he  was  concerned,  he 
thought  enough  of  this  celebrated  institution  to  address  a 
printed  card  to  the  "Physicians  and  Surgeons  of  the  West, 
and  particularly  to  the  Medical  Faculty  and  Class  at 
Lexington,"  when  his  claims  to  the  first  ovariotomy 
were  challenged. 

That  modesty  and  a  retiring  disposition  were  charac- 
teristics of  McDowell  there  is  no  doubt.  Many  writers 
have  carried  this  idea  so  far  as  to  insist  that  had  it  not 
been  for  his  friends  and  relatives,  notably  Dr.  Samuel 
Brown,  his  college  companion,  and  Dr.  William  A. 
McDowell,  his  nephew,  he  might  never  have  published 
the  reports  of  his  ovarian  surgery.  With  this  view  we  have 
no  sympathy  whatever.  Probably  to  those  of  his  friends 
who,  had  they  been  in  his  position,  would  have  rushed 
into  print  immediately  after  the  fate  of  the  first  ovari- 
otomy was  assured,  this  seeming  indifference  was  strangely 
incomprehensible. 

Various  pleas  are  said  to  have  been  presented  in  urging 

211 


EPHRAiM  McDowell 

him  to  publish  his  cases,  such  as  that  "he  owed  it  to  his 
teacher,  John  Bell,"  or  "he  owed  it  to  himself";  and 
according  to  Gross,  his  classmate  Samuel  Brown  asked 
that  he  and  his  friends  be  permitted  to  draw  up  an  account 
of  his  cases  of  ovariotomy  in  Latin,  in  order  that  it  might 
be  sent  to  Edinburgh  to  secure  a  degree. 

All  of  this  most  likely  occurred;  but  even  so,  it  is 
impossible  to  beheve  that  McDowell,  after  hearing  what 
he  must  have  heard  while  at  Edinburgh — for,  as  we  have 
before  mentioned,  even  by  that  time,  which  was  at  least 
fourteen  years  before  the  first  ovariotomy,  the  subject 
was  thoroughly  ripe,  and  all  that  was  lacking  was  the  man 
and  the  hour — in  the  face  of  all  this,  was  not  aware  of  the 
importance  of  his  deed.  In  fact,  to  take  any  other  view 
would  be  discreditable  to  McDowell,  and  a  reflection 
upon  his  intelligence  but  neither  he  nor  anyone  else  at 
that  time  could  have  had  the  remotest  conception  of  the 
direct  and  indirect  significance  of  this  step.  It  seems  im- 
possible, we  repeat,  for  anyone  to  believe  for  a  moment 
that  he  failed  to  appreciate  the  importance  of  the  experi- 
ment, as  he  called  it,  and  when  it  proved  successful, 
that  he  did  not,  in  part  at  least,  realize  its  significance, 
even  though  the  idea  of  its  becoming  the  basis  of  the  future 
sphere  of  abdominal  surgery  was  then  not  even  dreamt  of. 
Furthermore,  what  is  of  still  greater  significance  is  that, 
when  he  did  act,  he  did  not  send  the  report  to  John  Bell 
alone,  as  it  was  suggested,  but  he  sent  one  copy  to  John 
Bell  and  another  to  Philip  Syng  Physick,  with  the  idea 
of  having  the  report  appear  as  nearly  simultaneously  as 
possible  on  this  and  the  other  side  of  the  Atlantic. 

It  is  useless  to  say  that  one  who  was  careful  enough 
to  take  such  precautions  could  be  indifferent  to  the  full 
importance  of  the  work  which  the  report  represented. 

212 


THE  PERSONAL  SIDE  OF  DR.  EPHRAIM  McDOWELL 

After  all,  since  ovariotomy  at  that  time  could  not  have 
been  considered  in  any  other  light  than  that  of  an  experi- 
ment, since  it  was  specifically  referred  to  by  him  as  an 
experiment,  and  since  he  with  characteristic  reserve 
referred  to  his  results  as  due  mainly  to  his  good  fortune, 
would  it  not  be  more  reasonable  to  assume  that  he  dis- 
played not  indifference  but  good  judgment  in  waiting, 
and  repeating  the  experiment  until  it  ceased  to  be  an 
experiment,  and  became  a  proven  fact? 

This  would  seem  to  be  a  more  logical  view  to  take, 
and  it  would  not  be  incompatible  with  the  degree  of 
intelligence  to  which  McDowell  is  distinctly  entitled. 
What  delay  there  was  in  the  pubhcation  that  could  not  be 
explained  upon  this  basis  is  readily  understood,  if  we  bear 
in  mind  that  events  did  not  move  as  rapidly  then  as  they 
do  today,  and  that  the  nature  of  his  practice,  in  the 
absence  of  modern  conveniences,  so  consumed  his  time 
as  to  leave  but  little  opportunity  for  literary  work,  even 
if  he  were  so  inclined. 

That  the  appearance  of  his  report  on  the  other  side 
of  the  Atlantic  was  seven  years  behind  its  publication  on 
this  side  was  not,  however,  due  to  any  lack  of  effort  upon 
the  part  of  McDowell  himself,  but  can  be  wholly  credited 
to  lack  of  confidence  on  the  part  of  Lizars. 

McDowell  is  described  as  nearly  six  feet  in  height, 
erect,  and  inclined  to  corpulency,  with  a  florid  complexion 
and  lustrous  black  eyes.  The  eyes  were  so  piercingly 
black  as  to  have  received  a  special  mention  upon  various 
occasions.  Even  in  this  day  those  who  are  acquainted 
with  some  of  his  kinsmen  and  descendants  can  hardly 
fail  to  be  impressed  with  this  family  feature,  so  strikingly 
met  with  in  the  typical  McDowell  physiognomy.  Through- 
out his  life  he  was  noted  for  his  strength  and  agility,  and 
up  to  the  time  of  his  last  illness  he  was  in  a  well  preserved 

213 


EPHRAiM  McDowell 

state  of  health.  He  was  quite  entertaining,  and  possessed 
a  ready  wit  and  keen  sense  of  humor.  In  an  unpretentious 
way  he  was  fond  of  music.  He  would  sing  English  and 
Scotch  songs  with  comic  effect,  accompanying  himself 
upon  his  violin,  upon  which  he  performed  with  ordinary 
ability.  With  the  modesty  and  simplicity  of  a  great 
man,  he  mingled  with  absolute  freedom  with  all  classes 
of  his  townspeople. 

In  a  private  letter  a  well-known  physician,  whose 
uncle  lived  in  Danville,  and,  at  the  time  of  McDowell, 
was  nine  years  of  age,  said  that  McDowell  was  referred 
to  by  this  uncle  as  "a  silent,  phlegmatic  man,  and  the 
common  opinion  was  that  he  was  vastly  overrated."  The 
letter  further  stated  that  a  contemporary  and  competitor 
said  of  him  that  "  he  went  to  Edinburgh  a  gosling,  and 
that  Edinburgh  made  a  goose  of  him." 

He  is  said  not  to  have  used  tobacco  in  any  form,  and  to 
have  been  temperate  in  his  habits.  Occasionally  he  would 
take  a  "nip"  of  whiskey  or  cherry  bounce,  the  latter  being 
his  favorite.  Cherry  bounce  was  an  old-fashioned  bever- 
age, that  consisted  of  whiskey  in  which  cherries  had 
been  macerated,  and  to  which  sugar  and  spices  were  some- 
times added.  It  is  reported  that  in  his  dress  he  was 
neat,  and  invariably  preferred  black.  Some  have  refer- 
red to  him  as  wearing  a  silk  stock  and  ruffled  linen, 
but  if  he  did,  we  think  it  was  on  state  occasions,  for  his 
mode  of  living  was  "plain  and  unostentatious,"  in  keep- 
ing with  the  frontier. 

His  foreign  training  and  Scotch  origin  explained  his 
preference  for  Cullen  and  Sydenham  in  medicine,  and 
Burns  and  Scott  in  literature. 

He  was  no  writer;  his  only  contributions  to  medical 
literature  are  the  two  reports  in  the  Eclectic  Repertory  and 
Analytical    Review    upon    his    ovarian    operations.      His 

214 


THE  PERSONAL  SIDE  OF  DR.  EPHRAIM  McDOWELL 

library,  considering  his  time  and  place,  was  a  credit  to 
him,  and  in  matters  of  education  he  was  found  doing  his 
full  duty.  His  support  of  and  connection  with  Centre 
College  amply  sustain  this  view,  as  well  as  emphasizing 
his  public-spiritedness  in  general. 

As  was  common  in  those  times  and  in  that  region, 
every  well-to-do  family  possessed  a  farm,  and  McDowell 
was  no  exception  to  this  rule.  This  was  managed  through 
an  overseer,  and  the  breeding  of  fine  horses  and  swine 
became  with  him  a  special  feature.  The  former  of  these 
represented  a  characteristic  that  no  genuine  Kentuckian, 
especially  of  the  earlier  type,  could  be  expected  to  resist. 
In  a  small  way,  and  for  his  immediate  needs,  he  kept  a 
few  slaves,  as  was  then  customary. 

McDowell  was  not  a  rich  man,  but  he  safely  came 
within  that  class  referred  to  in  common  parlance  as 
"well-to-do."  His  estate  is  supposed  to  have  been  worth 
somewhere  between  forty  and  fifty  thousand  dollars. 
While  he  lived  plainly,  he  did  not  deny  himself  or  his 
family  any  of  the  comforts  of  life  which  that  simple 
period  afforded.  Considering  his  well-known  generosity 
to  his  patients,  his  philanthropic  attitude  towards  his 
town,  and  the  cheapness  of  commodities  in  relation  to 
the  value  of  money  at  the  time,  it  is  evident  that  he  had 
a  prosperous  career.  He  did  his  full  share  of  charity,  but 
his  fees  were  the  best.  In  the  noted  Overton  case,  which 
was  one  of  his  ovariotomies,  he  stipulated  a  fee  of  five 
hundred  dollars,  but,  it  is  said,  received  fifteen  hundred 
dollars,  which  sum  the  husband  insisted  more  nearly 
represented  the  value  of  his  services. 

He  remained  with  this  case  for  several  days  after  the 
operation.  Gross  refers  to  this  as  "the  largest  fee  ever 
paid  in  this  country  for  a  surgical  operation."  Consider- 
ing all  circumstances  on  both  sides.  Gross   regards  the 

215 


EPHRAiM  McDowell 

Overton  fee  as  equal  to  the  celebrated  fee  of  a  thousand 
guineas,  paid  by  Mr.  Hyatt,  a  West  Indian  merchant, 
for  an  operation  performed  upon  him  by  Sir  Astley  Cooper. 

The  religious  atmosphere  of  McDowell's  early  life  was 
Presbyterian,  a  faith  for  which  the  Scotch-Irish  settlers  of 
that  part  of  Virginia  were  noted.  When  the  frontier  was 
moved  over  the  Western  slope  of  the  Alleghanies,  the  re- 
ligious ardor,  from  all  accounts,  did  not  improve  with  the 
removal.  It  was  not  until  1828,  or  about  two  years  before 
his  death,  that  he  joined  the  Episcopal  Church,  the  faith 
of  his  wife.  He  became  a  member  of  the  church  at  Lexing- 
ton, presumably  because  there  was  no  Episcopal  church 
in  Danville,  for  on  his  return  from  Lexington  he  donated 
a  lot  upon  which  the  Trinity  Church  of  Danville  was  erected. 

In  1802,  in  the  thirty-first  year  of  his  age,  he  married 
Miss  Sarah  Hart  Shelby,  the  daughter  of  Isaac  Shelby, 
Kentucky's  first  Governor.  At  the  time  of  her  marriage 
Miss  Shelby  was  in  her  eighteenth  year.  She  has  been 
spoken  of  as  ''graceful  and  of  commanding  height,"  and 
possessed  of  great  personal  beauty,  and  charming  manners. 
The  marriage  occurred  at  Travelers'  Rest,  the  home  of 
Governor  Shelby,  which  Collins  claims  was  the  first  stone 
house  built  in  Kentucky. 

Between  the  Shelbys  and  the  McDowells  an  intimate 
friendship  existed,  extending  over  many  years.  McDowell's 
father  was  a  comrade-in-arms  with  Isaac  Shelby,  both 
having  served  in  Dunmore's  War  and  the  Revolutionary 
War.  In  the  former,  at  the  battle  of  Point  Pleasant,  he 
acted  as  aide-de-camp  to  Shelby. 

Six  children  were  born  to  this  union,  two  sons  and  four 
daughters.  Of  the  children,  Shelby,  the  youngest,  died 
in  childhood  of  suffocation,  the  result,  it  is  said,  of  inhaling 
a  wheat-spear.  This  occurred  during  the  absence  of 
Doctor  McDowell. 

216 


Traveler's  Rest:  The  home  of  Governor  Isaac  Shelby,  where   McDowell's  wedding 

was  solemnized.     Erected  in   1786.      Copied  from   a  photograph    loaned    by    Mr. 

Isaac  Shelby  Tevis. 


THE  PERSONAL  SIDE  OF  DR.  EPHRAIM  McDOWELL 

The  second  son  was  named  after  Judge  Caleb  Wallace. 
Wallace  McDowell  married  Miss  Mary  Hall,  of  Shelby- 
County,  Kentucky.  After  a  residence  of  several  years  on 
a  farm  in  Boyle  County,  he  removed  to  Missouri,  where 
he  died. 

Susan  McDowell,  the  eldest  daughter,  married  Col. 
David  C.  Irvine,  of  Madison  County,  Kentucky. 

Mary  McDowell,  the  second  daughter,  married 
her  cousin  once  removed,  George  Young,  a  farmer  of 
Shelby  County. 

Adaline  McDowell,  the  third  daughter,  married  Judge 
James  Deaderick,  of  Tennessee. 

Catherine,  the  last  and  youngest  of  the  surviving 
children,  married  Col.  A.  A.  Anderson. 

Mrs.  McDowell  survived  her  husband  by  ten  years, 
dying  at  the  home  of  her  daughter,  Mrs.  A.  A.  Anderson. 

Towards  the  close  of  his  career  McDowell  conceived 
the  idea  of  a  country  home,  to  which  he  would  at  times 
retire.  The  records  are  not  clear,  and  the  testimony  is 
conflicting,  as  to  how  long  before  his  death  he  busied  him- 
self upon  this  project.  According  to  Gross,  he  began  the 
building  of  this  country  home  a  few  months  before  his 
final  illness,  but  did  not  live  to  occupy  it,  or  even  to  see  it 
completed.    Ridenbaugh's  version  is: 

Several  years  previous  to  his  death  Doctor  McDowell  pur- 
chased a  highly  improved  tract  of  land,  with  a  modern  built, 
commodious  dwelling  upon  it,  situated  about  three  miles  from 
Danville.  Here  he  removed  with  his  family  with  a  view  to 
spending  the  remainder  of  his  life  in  quiet,  yet  with  no  intention 
of  giving  up  his  lucrative  practice,  which  had  grown  to  be 
very  extensive. 

Other  evidence  seems  to  harmonize  with  the  latter 
view,  which  is  very  likely  the  correct  version,  as  to  the 
location  of  his  residence  during  the  last  years  of  his  life. 

217 


EPHRAiM  McDowell 

This  country  home  was  called  Cambuskenneth,  after 
the  Abbey  of  Cambuskenneth,  near  Stirling.  The  selection 
of  this  name  for  his  country  home  was  but  an  echo  of 
those  summer  rambles  which  he  made  during  the  vacation 
months  while  in  Scotland,  and  that  remained  dear  to 
his  imagination, 

Stirling  is  about  thirty-five  miles  northwest  of  Edin- 
burgh, amid  the  most  picturesque  and  historic  region  of 
Scotland,  just  near  enough  and  attractive  enough  to  make 
a  pedestrian  tour  from  Edinburgh  during  the  vacation 
an  irresistable  treat.  In  the  immediate  vicinity  are  the 
beautiful  and  historic  ruins  of  Cambuskenneth  Abbey, 
founded  by  David  the  First,  in  1147.  It  was  the  wealth- 
iest Augustine  monastery  in  Scotland,  and  became  the 
burial-place  of  James  the  Third,  and  his  queen,  Margaret 
of  Denmark.  Within  the  sight  of  these  ruins  is  Stirling 
castle,  where  so  much  Scotch  history  was  made,  the  birth- 
place of  James  the  Second,  and  of  James  the  Fifth,  and  the 
place  where  James  the  Second,  in  the  year  1452,  stabbed 
the  rebellious  Earl  of  Douglas.  It  is  only  natural  that 
these  events,  recited  no  doubt  during  McDowell's  visit, 
should  have  made  a  lasting  impression  upon  his  memory. 

He  could  scarcely  have  given  his  country  home  a  more 
distinguished  name,  and  the  selection  clearly  reveals  his 
fondness  for  all  things  Scotch,  and  the  memories  that 
remained  the  tenderest  in  his  affections. 

The  house  now  occupying  the  site  of  Cambuskenneth 
is  not  the  original  McDowell  home.  In  the  summer  of 
191 2,  while  investigating  Danville  and  those  parts  of  the 
vicinity  that  are  intimately  associated  with  McDowell's  ac- 
tivities, we  were  informed  of  this  fact  by  the  late  Mr.  M.  H. 
Cecil,  who  then  resided  in  the  building  that  replaced  the 
original  McDowell  structure.    Mr.  Cecil  informed  us  that 

218 


Cambuskenneth.     The  country  home  of  McDowell 


THE  PERSONAL  SIDE  OF  DR.  EPHRAIM  McDOWELL 

the  original  McDowell  structure  had  a  defective  founda- 
tion, and  for  that  reason  it  did  not  last  as  long  as  it  was 
expected  to.  The  out-houses  and  other  features  within 
the  grounds  of  Cambuskenneth  remained  unchanged. 
The  accompanying  plate  is  a  copy  from  a  photograph  of 
the  original  McDowell  house. 

Throughout  his  life  McDowell  was  noted  for  his  vigor 
and  power  of  endurance,  together  with  a  comparative 
freedom  from  illness.  This  continued  until  a  fortnight 
before  his  death,  when  he  was  rather  suddenly  seized 
with  an  acute  attack  of  illness  that,  so  far  as  we  have 
been  able  to  gather,  was  marked  with  severe  abdominal 
pain  and  nausea  at  the  outset,  and  then  the  presence  of 
fever.  It  was  variously  referred  to  as  "inflammatory 
fever, "  and  as  "  an  acute  attack  of  inflammation  of  the 
stomach."  It  continued  for  two  weeks,  at  the  end  of  which 
he  expired.  We  have  made  a  diligent  but  fruitless  search 
for  the  names  of  his  medical  attendants  and  some  of  the 
details  of  his  last  illness. 

Taking  everything  into  consideration,  especially  the 
meager  clinical  history  of  his  final  illness,  we  are  tempted 
to  venture  the  suggestion  that  it  is  not  unlikely  that  he 
died  of  an  attack  of  acute  appendicitis.  Should  this  be 
correct,  and  it  seems  to  be  a  reasonable  explanation  of 
his  illness,  he  died  of  a  disease  that,  indirectly  through 
his  ovarian  surgery,  and  its  attending  lessons,  has  now 
become  amenable  to  surgical  measures,  and  therefore, 
through  the  indirect  fruits  of  his  labor,  had  he  lived  in  the 
present  day  he  might  easily  have  been  saved. 

As  to  the  exact  date  of  his  death  there  is  some  dis- 
crepancy. There  are  some  who  believe  that  he  died  on 
the  evening  of  June  20th,  1830,  and  others  who  give  the 
date  of  his  death  as  the  evening  of  June  25,  1830.  Among 
those  who  have  referred  to  June  20th  as  the  date  of  his 

219 


EPHRAiM  McDowell 

death  are  Mary  Young  Ridenbaugh  and  Mrs.  William  M. 
Irvine,  his  grand-daughters,  Dr.  John  D.  Jackson,  Dr. 
Fayette  Dunlap,  Dr.  W.  L.  Lowder,  Dr.  A.  H,  Barkley, 
Miss  Mary  C.  Shelby,  Lewis  Collins,  and  E.  Polk  Johnston. 

The  writers  who  believe  the  date  of  his  death  to  be 
June  25,  1830,  include  such  names  as  Samuel  D.  Gross, 
E.  Randolph  Peaslee,  The  Practitioner,  and  perhaps  others. 

We  have  found  but  one  author  who  has  used  both  the 
dates  of  his  birth  and  of  his  death.  Dr.  Lewis  S.  Mc- 
Murtry,  has  given  June  20,  1830,  as  the  date  of  his  death, 
in  his  sketches  upon  McDowell  in  the  Cyclopedia  of 
American  Medical  Biography,  Howard  A.  Kelly,  First 
Edition,Trans.  Amer.  Gynecological  Society, Vol.  XXXIV, 
1909,  Trans.  South.  Surg,  and  Gynec.  Ass.,  Vol.  VI, 
Historical  Number  Kentucky  State  Journal.  In  these 
publications  the  date  of  his  birth  is  given  by  McMurtry  as 
March  11,  1771,  which  is  unusual. 

In  McMurtry's  sketch  of  McDowell  in  the  Trans. 
Amer.  Med.  Ass.,  1878,  Vol.  XXIX,  the  date  of  his  birth 
is  given  as  November  11,  1771,  and  the  date  of  his  death 
as  June  25,  1830. 

Thus  in  the  first  four  publications  above  mentioned, 
McMurtry  gives  the  date  of  birth  as  March  11,  1771, 
and  the  date  of  death  as  June  20,  1830,  which  not  only 
places  him  at  variance  with  the  majority,  so  far  as  the 
date  of  birth  is  concerned,  but  in  contradiction  of  himself 
so  far  as  both  the  dates  of  birth  and  death  are  concerned, 
since  in  the  fifth  publication  just  referred  to,  the  Trans- 
actions of  the  Amer.  Med.  Ass.,  Vol.  XXIX,  he  places  the 
date  of  McDowell's  birth  as  November  11,  1771,  and  the 
date  of  his  death  as  June  25,  1830. 

Other  irregularities  as  to  the  date  of  his  death  exist 
that  can  only  be  explained  as  errors;  namely,  that 
given  by  Dr.  J.  Riddle  GofFe,  in  his  Presidential  Address 

220 


THE  PERSONAL  SIDE  OF  DR.  EPHRAIM  McDOWELL 

before  the  American  Gyneco  ogical  Association,  upon  the 
celebration  of  the  Centennial  Anniversary  of  McDowell's 
operation,  as  January  25,  1830,  {Surgery,  Gynecology  and 
Obstetrics,  May,  1909).  Likewise,  in  Mary  Young  Riden- 
baugh's  edition,  published  in  1890,  in  the  frontispiece 
which  she  borrowed  from  E.  Randolph  Peaslee's  work, 
November  17,  1771,  appears  in  very  fine  print  as  the  date 
of  his  birth,  and  June  25,  1830,  as  the  date  of  his  death, 
although  in  her  text,  she  gives  the  dates  which  are  usually 
credited,  November  11,  1771,  as  that  of  his  birth,  and 
June  20,   1830,   as  that  of  his  death. 

As  a  discrepancy  exists  both  as  to  the  dates  of  his  birth 
and  his  death,  we  may  be  permitted  to  add  that  so  far  as 
our  study  of  the  subject  goes,  a  decided  preponderance  of 
the  evidence  favors  November  11,  1771,  as  the  date  of  his 
birth,  and  June  20,  1830,  as  the  date  of  his  death.  We 
have  faithfully  endeavored  to  clarify  these  conflicting 
dates,  but  without  avail.  In  the  absence  of  official  records 
we  turned  to  his  church,  but  the  records  of  Trinity  Church, 
Danville,  extend  back  but  to  1839,  ^'^^  the  inscription 
upon  the  stone  that  covered  his  grave  gave  only  his  name, 
and  thus  was  equally  silent  upon  this  point. 

He  died  in  the  fifty-ninth  year  of  his  life,  and  his 
remains  were  interred  in  the  family  burial  ground  of  the 
Shelbys,  at  Travelers'  Rest,  about  five  miles  from  Danville. 

The  remains  of  his  wife,  who  survived  him  about  ten 
years,  were  placed  by  his  side.  Here  they  remained  within 
the  stone  walls  that  surround  this  private  cemetery,  and 
within  which  weeds  and  undergrowth  thrived  in  riotous 
profusion.  To  reach  the  graves  it  was  necessary  to  forge 
past  these  barriers. 

His  grave  was  left  undisturbed  until  1879,  when  his 
remains  were  removed  to  what  is  now  McDowell  Park, 
formerly  the  old  Danville  cemetery,  which  was  donated 

221 


EPHRAiM  McDowell 

by  the  citizens  as  a  site  for  the  erection  of  the  memorial 
monument.  This  occurred  through  the  activity  of  the 
Kentucky  State  Medical  Society. 

We  were  informed  by  Mr.  Isaac  Shelby  Tevis,  a 
descendant  of  the  Shelbys,  who  occupied  the  present 
Travelers'  Rest,  the  original  Travelers'  Rest  being  no 
longer  in  existence,  that  the  McDowell  grave  remained 
open  following  the  reinterment,  as  those  in  charge  were 
unable  to  decide  whether  the  remains  of  Mrs.  McDowell 
should  be  removed  with  those  of  her  husband.  Strange  to 
say,  this  remained  an  open  question  for  some  years,  un- 
til it  was  finally  referred  to  Dr.  J.  M.  Toner,  of  Washing- 
ton, D.  C,  who  settled  it,  by  directing  that  the  remains 
of  Mrs.  McDowell  be  removed,  and  placed  by  the  side 
of  those  of  her  distinguished  husband,  where  they  natu- 
rally belonged.  This  advice  was  acted  upon,  and  husband 
and  wife  now  rest  side  by  side  near  the  shaft  in  the 
McDowell  Park  in  Danville. 

In  the  accompanying  illustration  is  shown  a  consider- 
able depression  that  still  exists.  Our  photographer,  Mr. 
Hesse,  very  ingeniously  tied  his  handkerchief  into  the 
shape  of  an  arrow,  which  he  suspended  upon  two  sticks 
just  over  the  depression. 

In  looking  about  Travelers'  Rest  for  other  relics  asso- 
ciated with  McDowell,  we  discovered  the  broken  fragments 
of  the  stone  that  covered  his  first  grave.  In  view  of  our 
efforts  in  behalf  of  the  memory  of  his  distinguished  kins- 
man, Mr.Tevis  tenderly  offered  us  these  sacred  fragments, 
which  I  directed  to  be  carefully  crated  and  sent  to  Louisville. 
They  are  still  in  our  possession,  awaiting  a  decision  as  to 
where  they  should  be  placed  in  order  that  they  may  always 
receive  the  respect  and  reverence  they  deserve,  and  remain 
easily  accessible  to  those  who  may  be  sufficiently  interested 
therein  to  desire  a  close  view. 

222 


CHAPTER  XI 

THE    PORTRAITS    OF    McDOWELL THE    MOVEMENT    IN    HONOR    OF 

HIS  MEMORY — THE  MEMORIAL  MONUMENT  AND   DEDICATORY 
EXERCISES. 

There  are  several  portraits  of  McDowell  in  existence. 
The  tw^o  that  are  best  known  are  the  Jouett  and  the 
Davenport  portraits.  Of  these  two  the  reproduction  of 
the  one  attributed  to  Jouett  is  the  likeness  usually  met 
with.  We  meet  this  in  such  works  as  those  of  Peaslee, 
Memorial  Edition,  Wells,  Historical  Number  of  Ken- 
tucky State  Journal,  Ridenbaugh;  and  with  others  we  are 
inclined  to  believe  that  the  portrait  in  possession  of  his 
granddaughter,  Mrs.  Irvine,  is  but  a  reproduction  of  this 
same  painting.  Tracing  the  history  and  establishing 
the  identity  of  these  portraits  involved  considerable  dif- 
ficulty, and  even  now  the  matter  is  not  entirely  without 
some  suggestion  of  uncertainty  although  the  investiga- 
tion was   most  carefully  made. 

Two  letters  from  McDowell's  kinsman.  Dr.  Marshall 
McDowell  of  Cynthiana,  Kentucky,  upon  this  subject  are 
instructive,  to-wit: 

March  19,  1919. 
Dr.  August  Schachner, 
Louisville,  Kentucky. 

Dear  Doctor  Schachner: 

Several  days  ago  I  received  your  letter  making  inquiries 
concerning  Dr.  Ephraim  McDowell.  I  will  endeavor  to  answer 
them  in  the  order  that  they  occur  in  your  letter. 

First:  Col.  Nick  McDowell,  of  Danville,  who  died  several 
years  ago,  was  a  grandson  of  Doctor  McDowell's  brother,  Col. 
Joseph  McDowell. 

223 


EPHRAiM  McDowell 

Second  :  As  for  the  Bourbon  Co.  man  who  has  Doctor 
McDowell's  instruments — I  believe  the  story  was  that  the  man 
lived  in  North  Middletown.  I  got  this  story  from  a  drug  sales- 
man who  had  almost  passed  out  of  my  memory.  I  forget  his 
name.  I  asked  two  Bourbon  Co.  gentlemen,  Doctor  Fithian 
and  Doctor  Daugherty,  about  this,  but  neither  had  ever  heard 
of  any  such  man  or  instruments.  I  concluded  that  there  was 
nothing  in  the  story. 

Third:  It  seems  there  were  two  portraits  of  Doctor  Mc- 
Dowell. One  by  Jouett,  the  other  by  Davenport.  I  had  this 
from  my  grandfather,  who  was  a  nephew  of  Dr.  McDowell. 
I  don't  know  who  this  Davenport  was,  or  where  the  picture  was 
or  is.  My  grandfather  said  that  the  Jouett  picture  was  the 
better  likeness.  The  Jouett  portrait  was  carried  to  Missouri 
before  the  Civil  War  by  the  family  of  Doctor  McD's  daughter, 
Mrs.  Anderson.  Shortly  after  the  war  my  father,  who  was 
in  St.  Louis,  became  interested  in  the  picture.  So  he  and  his 
kinsman,  Dr.  John  McDowell,  of  St.  Louis,  wrote  to  E.  McD. 
Anderson,  grandson  of  the  old  Doctor,  for  permission  to  have  it 
photographed.  He  cut  the  canvas  from  its  frame,  rolled  it  up 
and  mailed  it  to  them.  The  photo  was  made,  and  the  canvas 
returned.  I  have  one  of  these  photographs.  It  plainly  shows 
cracks  in  the  oil  paint  caused  by  the  rolling  process.  The  photo 
which  you  sent  me  evidently  is  one  that  I  sent  you  and  is  a 
proof  from  a  negative  in  my  possession.  I  had  my  photograph 
photographed,  but  as  is  usual  in  such  cases  the  result  isn't  good. 
Besides  returning  yours  I  am  sending  you  a  copy  from  the  same 
negative  retouched.  I  agree  with  you  that  the  engraving  in 
the  memorial  volume  is  evidently  copied  from  this  same  picture. 
The  Jouett  portrait,  if  it  is  in  existence,  is  in  the  possession  of 
the  family  of  Ephralm  McD.  Anderson,  of  Sedalia,  Mo.  I  under- 
stand that  Mrs.  Elizabeth  Irvine,  of  Richmond,  Ky.,  a  grand- 
daughter of  Doctor  McDowell,  had  a  portrait  of  the  Doctor, 
but  I  don't  know  by  what  artist  or  whether  it  is  an  original 
or  a  copy. 

This  is  a  very  interesting  subject  to  me,  and  I  am  sorry  I 
haven't  any  more  exact  information  about  it. 

Yours  sincerely, 

(Signed)     M.  McDowell. 
224 


THE  PORTRAITS  OF  McDOWELL 

Cynthiana,  Kentucky,  April  5,  1919. 
Dr.  August  Schachner, 

Louisville,  Ky. 
Dear  Doctor  Schachner: 

Pursuing  the  subject  of  Dr.  Ephraim  McDowell's  picture.  The 
photograph  I  sent  you  is  a  reproduction  of  the  Jouett  portrait. 

I  have  never  known  anything  definite  about  the  Davenport 
portrait  other  than  the  statement  that  there  was  such  a  picture. 

If  you  have  a  copy  of  "Medical  Pioneers  of  Kentucky," 
published  by  the  Ky.  State  Med.  Ass'n  1917,  you  will  find  two 
pictures  of  Dr.  Ephraim  McDowell.  One,  the  frontispiece  of 
the  volume.  Is  the  Jouett  picture.  The  other  is  on  page  10,  facing 
the  text  of  the  biography  of  Doctor  McDowell  and,  published 
by  permission  of  the  American  Gynaecological  Soc.  No  artist 
named.  These  pictures  are  entirely  different.  I  find  it  difficult 
to  believe  that  they  represent  the  same  subject. 

I  think  I  shall  write  to  Doctor  McCormack,  the  editor  of 
the  "Pioneers,"  and  ask  for  information  concerning  the  Gynae- 
cological Society's  picture.     If  I  learn  anything  definite  I  will 

write  to  you  again.  ,;r  .  , 

I  ours  smcerely, 

(Signed)     M.  McDowell. 

The  artist,  Matthew  Harris  Jouett,  was  almost  as 
remarkable  as  a  painter  as  McDowell  was  as  a  surgeon. 
It  has  been  said  that  he  was  to  Kentucky  what  Rubens 
was  to  Flanders.  He  abandoned  the  pursuit  of  law  and 
began  to  paint  at  the  age  of  twenty-five.  He  died  at  the 
age  of  thirty-nine,  after  accomplishing  a  great  amount  of 
work  of  a  very  high  character  without  ever  leaving  the 
shores  of  his  own  country  for  inspiration  among  the  old 
masters.    His  is  truly  a  remarkable  record. 

Naturally,  one  would  expect  Jouett  to  have  painted  the 
portrait  of  McDowell  along  with  other  celebrities  of  his  time. 

In  the  Filson  Club  Publication  No.  17,  *'The  Old 
Masters  of  the  Blue  Grass,  by  General  Samuel  W.  Price," 
there  occurs  a  numerical  list,  with  titles,  of  Jouett's 
paintings.      This   was    painstakingly    prepared    by    Mr. 

IS  225 


EPHRAiM  McDowell 

Richard  Jouett  Menefee,  a  grandson  of  the  painter,  and 
one  eminently  fitted  for  the  task.  The  only  regret  is  that 
he  died  before  the  completion  of  the  undertaking.  There 
are  twenty-five  omissions  of  titles  in  this  list.  The  cata- 
logue, which  includes  a  total  of  three  hundred  and  thirty- 
four  paintings,  is  as  he  left  it  at  the  time  of  his  death, 
and  probably  is  incomplete  aside  from  the  aforesaid 
twenty-five  omissions. 

Ephraim  McDowell's  portrait  does  not  appear  in  the 
list,  and  there  is  nothing  to  indicate  that  it  may  be  among 
the  twenty-five  missing  titles.  The  catalogue  includes 
such  portraits  as  those  of  Samuel  McDowell,  Jr.,  the 
brother  of  Ephraim,  and  the  first  marshal  of  Kentucky, 
Walter  Brashear,  Benjamin  W.  Dudley,  his  college  com- 
panion, Dr.  Samuel  Brown,  and  that  of  his  father-in-law, 
Governor  Isaac  Shelby.  Notwithstanding  the  foregoing, 
we  agree  with  Dr.  Marshall  McDowell  and  other  relatives 
of  our  hero  that  the  evidence  justifies  the  belief  that  the 
portrait  most  commonly  met  with  is  the  work  of  Matthew 
Harris  Jouett. 

We  have  never  come  upon  in  any  publication  a  print 
of  the  Davenport  painting.  After  considerable  difficulty 
we  finally  secured  a  photograph  of  this  picture,  which  is 
in  the  possession  of  McDowell's  granddaughter,  Mrs. 
W.  T.  Chandler,  of  Alva,  Okla.  She  is  the  daughter  of 
William  Wallace  McDowell,  who  was  the  only  surviving 
son  of  the  first  ovariotomist.  She  was  born  in  Danville; 
her  father,  like  the  family  of  his  sister,  Mrs.  Anderson, 
also  moved  to  Missouri. 

We  regret  that  the  photograph  of  the  Davenport  paint- 
ing, while  sufficiently  clear  and  sharp  as  to  admit  of  a 
comparative  examination  with  that  of  the  photograph 
of  the  painting  supplied  by  Dr.  Marshall  McDowell,  and 
attributed  to    Jouett,    and  possessing   distinctive  differ- 

226 


THE  PORTRAITS  OF  McDOWELL 

ences  from  it,  is  not  of  sufficient  clearness  to  bear  satis- 
factory reproduction.  The  same  may  be  said  of  the 
Jouett  photograph  above  referred  to,  supplied  by  Dr.  Mar- 
shall McDowell.  On  the  back  of  the  Davenport  portrait, 
which  is  said  to  be  twenty-one  by  twenty-seven  inches  in 
size,  we  are  told  is  printed  "  P.  W.  Davenport,  painted  at 
Danville,  Ky.,  1820." 

As  for  Davenport,  we  have  been  unable  to  discover  any 
reference  to  this  artist  in  the  Kentucky  records  or  else- 
where. In  the  frontispiece  of  the  first  edition  of  her 
biography  of  McDowell,  dated  1890,  Mary  Young  Riden- 
baugh  refers  to  the  engraving  in  the  work  of  Edward  R. 
Peaslee,  which  she  borrowed,  as  an  engraving  "  from  a 
daguerreotype  furnished  by  the  late  Mrs.  McDowell." 
This  seems  erroneous  if  the  Smithsonian  Institute  is 
correct  in  its  claims  that  the  daguerreotype  camera  was 
not  introduced  into  the  United  States  until  1839,  or  nine 
years  after  McDowell's  death.  The  daguerreotype  camera 
was  in  fact  not  on  a  practical  working  basis  until  some 
time  after  1830,  the  year  in  which  he  passed  away.  In 
the  frontispiece  of  her  revised  edition,  published  in  1897, 
and  under  the  name  of  Mary  T.  Valentine  she  refers  to  this 
as  "a  portrait  by  Davenport  in  1828,  when  McDowell 
was  fifty-seven  years  of  age."  The  only  published  reference 
to  Davenport  which  we  have  found  occurred  in  the  above 
Mary  T.  Valentine's  biography  of  McDowell,  revised 
edition^  i8gy.  A  barren  inquiry  was  directed  to  the  Metro- 
politan Museum  of  Art  in  New  York,  and  the  Art  Insti- 
tute of  Chicago,  with  the  hope  of  securing  some  informa- 
tion   upon    the   artist    P.   W.   Davenport. 

Another  portrait  of  McDowell  is  that  occurring  as  a 
frontispiece  in  one  of  the  editions  of  the  biography  of 
McDowell  by  Mary  T.  Valentine,  who  is  none  other  than 
Mrs.  Mary  Young  Ridenbaugh.    This  occurs  in  the  so- 

227 


EPHRAiM  McDowell 

czlled  first  edition,  which  is  but  a  supplement  published 
in  1897  by  the  McDowell  Publishing  Company.  There 
are  three  editions,  and  four  publications,  and  these  three 
editions  differ  from  one  another  in  unimportant  minor 
details,  so  far  as  the  life  of  McDowell  is  concerned. 

These  editions  have  led  to  some  little  confusion,  and 
therefore  it  may  be  well  to  attempt  their  explanation. 
The  first  edition  was  issued  by  Mrs.  Mary  Young  Riden- 
baugh,  and  published  by  the  Charles  L.  Webster  Com- 
pany, of  New  York,  in  1890.  This  edition  bears  upon  the 
title  page  no  other  mark  of  identification.  Her  second 
and  subsequent  editions  upon  McDowell  were  issued 
in  the  name  of  Mrs.  Mary  T.  Valentine.  The  second 
edition  was  issued  in  1894,  ^^^  published  in  Philadel- 
phia by  the  authoress,  and  is  known  as  the  second  edition 
revised.  As  the  title  page  indicates,  it  contains  "  Sketches 
of  lives  of  eminent  members  of  the  medical  profession  in 
America,  Second  edition  revisedy*  but  the  sketches  are 
limited  in  number. 

The  third  edition  by  Mrs.  Mary  T.  Valentine  was 
issued  in  1897,  through  the  McDowell  Publishing  Com- 
pany, 24-26  West  22nd  Street,  New  York,  and  designated 
on  the  title  page  as  revised  edition. 

The  fourth  publication  by  Mrs.  Mary  T.  Valentine, 
which  is  but  a  supplement,  was  issued  in  1897,  through 
the  McDowell  Publishing  Company,  of  New  York,  and 
although  bearing  the  title  of  "Biography  of  Ephraim 
McDowell,"  and  with  a  title  page  similar  in  a  general  way 
to  that  of  the  other  publications,  with  the  specific  adden- 
dum of  First  Edition^  although  the  last  publication  is  no 
biography  of  McDowell  whatever.  This  publication  was 
issued  as  a  supplement  to  the  revised  edition  in  i8gy.  It 
is  a  work  of  over  four  hundred  pages,  containing  only 
portraits  and  sketches  of  prominent  living  surgeons  of 

228 


Portrait  of    Ephraim   McDowell,  by  Prof.   G.   Kasson   Knapp.    Reproduced  by  the 
kind  permission  of  his  daughter. 


THE  PORTRAITS  OF  McDOWELL 

that  period.  Apparently  it  is  an  enlargement  upon  the 
idea  in  the  second  edition  revised. 

In  her  reference  to  the  portrait  in  the  so-called  First 
Edition,  1897,  the  supplementary  volume  containing 
sketches  of  living  surgeons  only,  Mary  T.  Valentine  says : 
"The  above  portrait  is  a  reproduction  of  a  medallion 
painting  on  ivory  taken  from  life  when  Ephraim  McDowell 
was  twenty-nine  years  of  age,  1800,  by  a  distinguished 
artist  in  Edinburgh,  Scotland,  now  in  possession  of  Eph- 
raim McDowell's  granddaughter,  Mary  T.  Valentine." 

This  is  the  same  picture  that  was  utilized  by  the  Ameri- 
can Gynecological  Society  in  1909  at  their  McDowell 
Centennial  Anniversary  Celebration,  appearing  as  an 
illustration  of  the  text  descriptive  of  that  occasion.  We 
also  encounter  it  in  the  first  edition  of  the  Cyclopedia  of 
American  Medical  Biography,  by  Dr.  Howard  A.  Kelly, 
and  in  the  Historical  Number  of  the  Kentucky  Medical 
Journal,  November,  1917,  with  the  addendum  *'By  per- 
mission of  the  American  Gynecological  Society,"  al- 
though this  society  was  probably  not  the  first  to  bring 
it  before  the  public. 

It  is  the  same  reproduction  referred  to  by  Dr.  Marshall 
McDowell,  in  his  second  letter,  in  which  he  discussed  the 
dissimilarity  between  this  and  the  usually  accepted  por- 
trait, saying:  **I  find  it  difficult  to  believe  that  they 
represent  the  same  subject." 

The  explanation  of  this  portrait  given  by  Mary  T. 
Valentine  can  hardly  be  the  correct  one.  In  the  first 
place,  there  is  no  evidence  at  hand  justifying  the  belief 
that  McDowell  ever  left  the  shores  of  his  own  country 
but  once,  and  that  was  when  he  attended  the  University 
of  Edinburgh  in  1793  and  1794,  although  vague  references 
do  occur  as  to  his  having  later  in  life  gone  abroad  to  per- 
form a  Caesarean  section. 

229 


EPHRAiM  McDowell 

On  this  occasion  he  was  about  twenty-two  years  of  age, 
instead  of  twenty-nine,  the  latter  figure  being  just  nine 
years  prior  to  the  first  ovariotomy.  But  what  is  more  to 
the  point  is  that  irrespective  of  his  age,  while  in  Edinburgh, 
his  pecuniary  circumstances  would  hardly  have  permitted 
him  to  indulge  in  the  luxury  of  having  his  portrait  painted 
in  a  miniature  by  a  distinguished  artist,  even  if  he  at  that 
time  had  been  sufficiently  self-conscious  to  believe  the  step 
justifiable;  and  McDowell,  with  the  modesty  he  possessed, 
would  have  been  one  of  the  very  last  to  be  so  vain  as  to 
have  his  portrait  painted  while  an  obscure  student. 

It  would  be  absurd  for  anyone  in  McDowell's  position 
to  think  of  a  portrait,  after  receiving  the  letter  from  his 
father  from  which  the  following  extract  is  taken : 

I  would  be  glad  to  hear  how  you  like  your  situation  there, 

and  how  long  you  think  it  will  be  necessary  for  you  to  stay,  for 
I  assure  you  it  will  be  very  hard  for  me  to  send  you  a  supply  of 
money.  But  I  will  endeavor  to  support  you  if  in  my  power, 
and  to  enable  you  to  bring  with  you  some  books,  and  a  quantity 
of  medicine  to  serve  you  some  time,  and  to  set  up  a  decent  shop. 
But  I  fear  I  will  not  be  able  to  send  you  money  sufficient.  But 
if  you  had  it  in  your  power  to  get  credit  for  some  of  which  you 
might  think  would  be  necessary,  I  will,  I  hope,  be  able  in  a 
short  time  after  your  return,  to  make  a  remittance  to  pay  for 
the  medicine.  Is  there  no  person  trading  to  Scotland  to  whom 
you  could  apply? 

Were  it  not  that  one  of  the  objects  of  this  study  of 
McDowell's  life  is  to  help  correct  the  many  erroneous 
and  sometimes  ridiculous  statements  that  have  been  made 
in  the  past,  and  that  are  still  in  a  measure  being  perpetu- 
ated, no  more  than  a  passing  notice,  if  any,  would 
have  been  given  this  and  other  errors. 

The  last  of  the  portraits  that  we  have  discovered  is 
the  one  by  the  artist.  Prof.  George  Kasson  Knapp,  which 
is  here  reproduced  by  the  kind  permission  of  his  daughter. 

230 


THE  PORTRAITS  OF  McDOWELL 

This  same  artist  painted  the  picture  well  known  as 
the  "First  Ovariotomy,  '  that  has  appeared  a  number  of 
times,  and  with  an  almost  equal  number  of  varying  and 
misleading  titles.  The  history  of  these  paintings,  as 
well  as  some  interesting  sidelights  upon  the  artist,  has 
been  set  forth  in  a  special  paper  upon  the  subject  by  the 
late  Dr.  Ely  Van  de  Warker,  of  Syracuse,  New  York, 
and  published  in  the  Obstetric  Gazette,  Cincinnati,  Ohio, 
Vol.  I,  1879. 

For  some  reason  Professor  Knapp  became  deeply 
interested  in  McDowell  and  his  achievements.  He 
studied  the  man  and  his  work  from  every  viewpoint, 
and  utilized  every  source  of  information,  with  the  result 
that  he  concluded  to  paint  a  portrait  of  the  surgeon,  and 
a  picture  depicting  the  crowning  effort  of  his  life.  This  he 
did  as  his  imagination,  based  upon  his  study,  suggested 
to  him  McDowell's  probable  appearance,  and  how  the 
operation  was  probably  carried  out.  This  picture  was 
exhibited  at  one  of  the  annual  meetings  of  the  Ameri- 
can Medical  Association,  held  many  years  ago,  we  be- 
lieve, near  his  home  city,  in  Buffalo. 

During  McDowell's  life  his  labors  twice  received  public 
recognition;  in  18 17,  through  the  Medical  Society  of 
Philadelphia,  and  in  1825,  when  an  honorary  degree  was 
conferred  upon  him  by  the  University  of  Maryland.  This 
was  the  only  degree  ever  conferred  upon  him.  After  his 
death  his  memory  remained  unnoticed  for  practically  a 
half  century,  or,  to  be  exact,  from  1830,  the  year  of  his 
death,  to  1879,  the  year  in  which  the  dedicatory  exer- 
cises in  Danville  were  held. 

The  credit  and  honor  for  the  breaking  of  this  prolonged 
silence  belong  to  the  late  Dr.  John  Davies  Jackson,  a 
native  of  Danville. 

The  earliest  public  notice  of  Doctor  Jackson's  efforts 

231 


EPHRAiM  McDowell 

occurred  in  1872,  when  he  sounded  Dr.  Lewis  A.  Sayre 
of  New  York  as  to  the  propriety  of  erecting  a  monument 
to  Ephraim  McDowell.  Quite  naturally,  Doctor  Sayre 
gave  Jackson's  idea  his  hearty  approval. 

To  a  man  of  Jackson's  attainments,  with  his  alert 
mind  and  his  keen  sense  of  propriety,  the  idea  of  honoring 
such  a  benefactor  must  have  occupied  his  thoughts  for 
some  time  before  he  ever  consulted  Doctor  Sayre.  It  is 
a  matter  of  regret  that  Jackson  died  so  early,  as  he 
seemed  so  eminently  fitted  for  this  task,  which  was  easily 
worthy  of  the  best  efforts  of  his  life.  It  is  true  that  the 
movement  which  he  started  was  taken  up  where  he  left 
it,  and  finally  completed  by  others.  But  there  was  so  much 
more  that  in  time  could  have  been  done,  and  that  probably 
would  have  impressed  itself  upon  Jackson  had  he  lived  to 
continue  his  interest  and  efforts,  with  the  result  that  the 
details  of  McDowell's  life  and  the  objects  pertaining  to 
his  career  and  his  labors  would  to-day  be  in  a  state  of 
preservation  and  recognition  somewhat  commensurate 
with  the  unbounded  importance  that  the  work  of  Mc- 
Dowell represents. 

Unfortunately,  Jackson  did  not  live  to  complete  the 
forty-first  year  of  his  life,  but  died  of  tuberculosis  Decem- 
ber the  eighth,  1875.  He  received  his  education  at  Centre 
College,  and  spent  his  life  in  Danville.  He  was  a  man  of 
unusual  attainments,  with  high  ideals  and  a  mind  ma- 
tured and  broadened  through  travel.  Three  years  before 
his  death  he  began  to  carry  out  his  idea  by  interro- 
gating Doctor  Sayre  and,  no  doubt,  others.  Encouraged 
by  their  approval,  he  set  about  his  task,  but  as  matters 
moved  in  so  short  a  space  of  time  as  three  years,  little 
more  than  a  definition  could  be  given  the  movement 
to  erect  a  monument  which,  although  highly  commend- 
able, was  after  all  but  a  very  modest  beginning. 

232 


THE  PORTRAITS  OF  McDOWELL 

Jackson  began  by  introducing  his  idea  into  the  Boyle 
County  Medical  Society.  From  here  it  was  extended  to 
the  Kentucky  State  Medical  Society  and  the  American 
Medical  Association,  the  national  body.  Commendable  as 
it  was,  unfortunately,  the  farther  it  extended  the  weaker 
it  grew.  Most  likely  if  he  had  lived,  he  would  have  re- 
mained behind  the  movement  and  kept  its  interest  alive. 
As  it  was,  by  the  time  it  reached  the  American  Medical 
Association,  it  rapidly  died  of  inanition. 

As  a  matter  of  history,  the  progress,  or  lack  of  progress, 
of  the  movement,  whichever  way  you  care  to  view  it,  in 
the  state  and  national  bodies  is  of  sufficient  interest  to 
make  a  repetition  of  the  records  desirable.  We  begin 
with  the  twenty-fifth  volume  of  the  Transactions  of  the 
American  Medical  Association,  1874,  ^^i  which  Dr.  J.  M. 
Keller  acting  upon  the  request  from  the  Boyle  County 
Medical  Society,  introduced  the  initial  resolution  into  the 
American  Medical  Association,  to-wit: 

These  records  are  reprinted  from  the  Transactions, 
Amer.  Med.  Asso.,  Vols.  25,  26  and  27.  From  Vol.  25, 
1874  we  are  told  that  Doctor  Keller,  of  Kentucky, 
announced  that  he  had  been  requested  by  the  Society  of 
Boyle  County,  Kentucky,  to  bring  before  the  Associ- 
ation the  following  resolutions  adopted  by  that  Society 
in  reference  to  the  late  Dr.  Ephraim  McDowell. 

"Resolved,  That  in  the  opinion  of  this  Society  the 
time  has  come  in  which  an  effort  should  be  made  to  erect 
a  statue  or  some  other  suitable  memorial  in  honor  of  Dr. 
Ephraim  McDowell,  *the  father  of  ovariotomy,'  who 
lived  and  died  in  our  midst,  and  who  performed  his  first 
operation  for  ovarian  tumor  here  in  Danville,  in  1809. 

"That  with  this  view  a  committee  of  three  be  appointed 
from  this  Society  to  attend  the  approaching  meeting  of 

233 


EPHRAiM  McDowell 

the  Kentucky  State  Medical  Society,  who  shall  be  em- 
powered to  lay  the  matter  before  the  profession  consti- 
tuting that  organization,  requesting  their  aid  in  devising 
and  executing  such  measures  as  may  be  deemed  most 
conducive  to  the  end  in  view." 

Doctor  Keller,  after  reading  the  foregoing,  offered  the 
following  preamble  and  resolutions: 

"Whereas,  A  most  laudable  effort  has  recently  origin- 
ated in  the  Boyle  County  Medical  Society  of  the  State  of 
Kentucky  and  in  the  Kentucky  State  Medical  Society,  to 
create  a  fund  for  the  erection  of  a  statue  or  some  other 
suitable  memorial  in  honor  of  Dr.  Ephraim  McDowell, 
'the  father  of  ovariotomy,'  English  writers  to  the  con- 
trary notwithstanding,  who  lived  in  the  town  of  Danville, 
in  the  State  of  Kentucky,  and  who  performed  in  that  town 
the  first  ovariotomy  in  the  year  1809: 

"Resolved,  That  the  American  Medical  Association 
most  earnestly  indorse  the  action  of  the  said  County  and 
State  Societies,  and  as  urgently  commend  the  object  to 
the  generous  consideration  of  the  medical  profession  of 
the  world." 

After  a  discussion,  the  resolutions  were  adopted. 

From  Vol.  26,  1875,  Dr.  J.  Marion  Sims,  N.  Y.,  read 
the  Report  of  the  Committee  on  the  McDowell  Memorial 
Fund,  which  on  motion  was  received,  and  the  resolutions 
were  unanimously  adopted. 

"Whereas,  It  is  universally  acknowledged  that  the  late 
Ephraim  McDowell,  of  Kentucky,  was  the  originator  of 
the  operation  of  ovariotomy; 

"And,  whereas,We  beheve  that  proper  measures  should 
be  instituted  to  commemorate  this  great  achievement,  and 
do  appropriate  honor  to  its  author;  therefore: 

234 


THE  MOVEMENT  IN  HONOR  OF  HIS  MEMORY 

"Resolved,  That  this  Association  recommend  to  each 
of  its  members,  and  to  the  profession  generally,  to  con- 
tribute annually  such  sums  as  they  may  think  proper  until 
the  amount  of  ten  thousand  dollars  shall  be  accumulated, 
which  shall  be  known  as  the  McDowell  Memorial  Fund, 
the  interest  of  which  shall  be  devoted  to  the  payment  of 
prizes  for  the  best  essays  relating  to  the  diseases  and  sur- 
gery of  the  ovaries. 

"Resolved,  That  this  fund  shall  be  invested  by  trustees 
to  be  appointed  by  the  Association,  and  subject  to  such 
regulations  as  it  may  devise. 

"Resolved,  That  this  Association  shall  elect  a  board  of 
three  trustees,  whose  duty  it  shall  be  to  carry  out  the 
object  of  these  resolutions,  and  whose  term  of  office  shall 
continue  five  years. 

"Resolved,  That  this  Association  will  leave  to  the  State 
of  Kentucky  the  grateful  privilege  of  providing  a  local 
memorial  to  the  memory  of  Doctor  McDowell." 

Respectfully  submitted, 

J.  Marion  Sims,  New  York, 
Washington  L.  Atlee,  Pa., 
W.  H.  Byford,  IlHnois, 
J.  M.  Keller,  Kentucky. 

On  motion  of  Dr  J.  Morris,  Maryland,  the  following 
were  appointed  Trustees  of  the  McDowell  Memorial 
Fund: 

Drs.  Washington  L.  Atlee,  Pennsylvania;  W.  H.  By- 
ford,  Illinois;  J.  M.  Keller  and  J.  D.  Jackson,  Kentucky; 
and  J.  Marion  Sims,  New  York. 

Dr.  L.  P.  Yandell,  Chairman  of  Committee  on  Prize 
Essays,  reported  as  follows: 

The  Committee  on  Prize  Essays  beg  leave  to  report 
that  they  have  received  a  number  of  essays,  carefully 

235 


EPHRAiM  McDowell 

written  and  marked  by  various  degrees  of  merit.  But 
after  as  careful  an  examination  of  them  as  the  committee 
have  had  time  to  make  they  are  not  prepared  to  recom- 
mend any  as  worthy  of  the  prize  offered  by  the  Associa- 
tion. One  of  the  papers  submitted  to  your  committee  is 
a  work  of  vast  dimensions.  It  makes  four  volumes,  and 
an  aggregate  of  more  than  twelve  hundred  pages.  The 
committee  have  found  it  utterly  impracticable  in  the 
time  at  their  disposal  to  look  through  this  elaborate  paper. 
It  treats  of  "Excision  of  the  Larger  Joints,"  and  strikes 
the  committee  as  worthy  of  a  careful  examination.  They 
would  therefore  recommend  that  it  be  submitted  to  a 
committee  of  experts,  to  be  reported  upon  at  the  next 
meeting  of  the  Association. 

Respectfully  submitted, 

L.  P.  Yandell, 

Chairman. 

Vol.  27, 1876,  Dr.  J.  M.  Keller  read  the  report  from  the 
McDowell  Memorial  Fund: 

Report  from  Trustees  of  McDowell  Essay  Fund 

Total  amount  of  subscriptions  received  to  date ^494 

Amount  of  expenditures 340 

Amount  in  hands  of  Treasurer ^IS4 

"Resolved,  That,  until  the  sum  often  thousand  dollars 
be  raised,  the  annual  fee  of  membership  be  increased  from 
five  dollars  to  six  dollars,  and  that  this  increase  of  one 
dollar  be  set  aside  to  create  the  fund. 

On  motion  of  Dr.  J.  M.  Toner,  the  report  was  accepted. 

Dr.  S.  C.  Busey,  objected  to  the  change  in  the  dues. 

Dr.  L.  D.  Waterman,  of  Indiana,  moved  to  appoint  a 
committee  of  seven  to  take  up  a  collection  at  once. 

On  motion  of  Dr.  J.  L.  Atlee,  of  Pennsylvania,  this 
was  laid  on  the  table. 

236 


THE  MOVEMENT  IN  HONOR  OF  HIS  MEMORY 

Dr.  Toner  moved  to  appropriate  ^looo  from  the 
treasury. 

Dr.  E.  L.  Howard,  of  Maryland,  rose  to  a  point  of 
order,  that  such  matters  could  be  considered  only  on  the 
first  and  fourth  days. 

On  motion  of  Dr.  Robert  Reyburn,  D.  C,  Dr.  Toner's 
resolution  was  laid  on  the  table  till  to-morrow. 

On  motion  of  Dr.  J.  J.  Woodward,  D.  C,  the  regular 
order  of  business  was  resumed. 

From  the  foregoing  it  is  evident  that  a  division  of 
labor  resulted,  in  which  the  American  Medical  Association 
essayed  the  creation  of  a  Memorial  Prize  Fund  of  ten 
thousand  dollars,  the  interest  of  which  should  be  devoted 
to  the  payment  of  prizes  for  the  best  essays  relating  to 
the  diseases  and  surgery  of  the  ovaries,  whereas  to  the 
Kentucky  State  Medical  Association  fell  the  task  of  erect- 
ing a  memorial  monument. 

The  efforts,  and  their  results,  of  the  American  Medical 
Association  are  best  described  by  Gross,  in  a  footnote  to 
his  dedicatory  address  as  follows: 

All,  in  fact,  that  the  American  Medical  Association  did  was 
to  pass  an  empty  resolution,  leaving,  as  the  illustrious  chair- 
man, Dr.  J.Marion  Sims, expressed  it,  "to  Kentucky  the  grateful 
privilege  of  providing  a  local  monument  to  the  memory  of  Doctor 
McDowell,"  and  requesting  the  Association  to  contribute 
through  its  individual  members  the  sum  of  ten  thousand  dollars 
as  a  fund,  to  be  called  the  "McDowell  Memorial  Fund,"  to  be 
devoted  to  the  payment  of  prizes  for  the  best  essays  relating 
to  the  diseases  and  surgery  of  the  ovaries.  This  fund  is  still 
unborn,  and  it  is  not  probable  that  it  will  receive  any  further 
attention  from  the  Association. 

The  first  records  of  this  movement  in  the  Kentucky 
State  Medical  Society  were  encountered  in  the  **  Trans- 
actions of  the  nineteenth  meeting'*  held  in  Shelby ville, 
1874,  as  follows: 

237 


EPHRAiM  McDowell 

Dr.  J.  D.  Jackson,  after  a  few  remarks  touching  the  prone- 
ness  of  Americans  to  lose  sight  of  their  great  and  world-famed 
men  of  genius,  presented  the  following  resolutions  from  the 
Boyle  County  Association: 

"Resolved,  That  in  the  opinion  of  this  Society.it  is  proper 
that  an  organized  effort  be  made  to  erect  a  memorial  statue  to 
the  memory  of  Dr.  Ephraim  McDowell,  'the  father  of  ovari- 
otomy,' who  performed  the  first  operation  of  the  removal  of  an 
ovarian  tumor  at  Danville,  Ky.,  in  the  year  1809. 

"Resolved,  That  the  Kentucky  State  Medical  Society  be 
requested  to  sanction  these  resolutions." 

John  D.  Jackson, 
Ely  McClellan, 
J.  M.  Meyer. 

Referred  to  Doctors  Jackson,  McClellan,  Keller,  and  Meyer, 
with  instructions  to  report  the  most  practicable  means  of  raising 
the  necessary  funds. 

Doctor  McClellan  said  it  had  been  suggested  to  him  that 
the  women  rescued  by  the  "ovarian  method"  be  requested  to 
erect  this  monument  in  gratitude  to  their  great  benefactor. 

In  the  same  Transactions,  Dr.  J.  W.  Thompson,  of 
Paducah,  in  his  Presidential  address  pays  a  splendid 
tribute  to  the  memory  of  McDowell  and  makes  an  earnest 
appeal  in  behalf  of  the  efforts  of  Jackson. 

The  reprinting  of  this  section  of  Doctor  Thompson's 
address  is  for  more  reasons  than  one  deemed  appropriate. 

McDowell  Monument 

There  is  a  name  which  stands  as  a  priceless  gem  in  the 
history  of  Kentucky  medicine  and  surgery — the  name  of 
Ephraim  McDowell,  We  all  bow  with  reverence  to  his  memory. 
His  wonderful  discovery  and  distinguished  services  should 
incite  us  to  guard  and  protect  the  legacy  of  his  exalted  genius, 
not  only  as  a  measure  of  justice  to  him,  but  to  Kentucky  surgery, 
on  whose  historic  page  his  name  stands  highest.  Such  services 
should  be  rewarded  by  a  monument  whose  shaft  should  reach 
high  above  the  bushes  and  briers  that  now  cover  his  lonely  grave 
in  the  cemetery  of  General  Shelby,  in  Lincoln  County,  in  this 

238 


THE  MOVEMENT  IN  HONOR  OF  HIS  MEMORY 

state.  The  monument  must  be  reared,  and  the  responsibility 
of  building  it  is  upon  this  Society.  Upon  us  rests  the  "labor  of 
love"  of  perpetuating  the  fame  of  him  who  originated  and  suc- 
cessfully established  the  operation  of  ovariotomy,  which  "has 
given  to  woman  more  than  thirty  thousand  years  of  actual  life." 

The  women  of  the  world  ought  to  have  erected  this  monu- 
ment long  ago,  and  I  doubt  not  that  our  present  efforts  will 
receive  their  hearty  cooperation.  It  should  be  a  matter  of  pride 
to  them  and  the  medical  profession,  and  indeed  to  civilized 
people  throughout  the  world,  to  aid  in  paying  this  just  tribute 
to  his  genius.  But  if  unaided  from  any  quarter  whatever,  we 
must  preserve  the  memory  of  one  who  reflected  so  much  honor 
on  the  medical  reputation  of  our  state  by  the  renown  he  has 
secured  in  this  country  and  in  the  whole  civilized  world,  and 
who  even  up  to  this  time  is  quoted  with  more  reverence  than 
those  to  Kentucky's  distinguished  sons  whom  we  are  all  proud 
to  claim. 

It  is  true  that  the  selfish  vanity  of  some  medical  men  in 
Europe  has  caused  them  to  endeavor  to  snatch  from  him  the 
credit  of  the  one  achievement  which  alone  would  yield  undying 
fame.  But  facts  valuable  to  history  and  to  justice  will  not 
permit  it,  and  never  while  I  can  raise  my  voice  or  move  my  pen 
will  I  in  silence  allow  one  leaf  to  be  plucked  from  the  wreath 
that  entwines  his  brow. 

If  he  could  be  consulted,  he  would  doubtless  prefer  to  have 
his  last  resting  place  marked  as  it  is — "E.  McDowell"  upon  a 
simple  slab;  but  our  admiration  for  such  an  illustrious  medical 
character  should  make  us  unwilling  that  he  who  has  done  so 
much  good  and  added  so  much  glory  to  Kentucky  surgery  should 
lie  in  such  a  neglected  place.  If  his  history  belonged  to  England, 
France,  Russia,  or  any  other  country  in  Europe,  the  marble 
column  with  the  tallest  spire,  indicative  of  the  mental  height  of 
him  who  rested  there,  would  mark  the  spot  where  so  much  great- 
ness lies.  And  we  must  not  be  behind  them.  It  belongs  to 
Kentucky  medicine  and  surgery  to  do  this  work,  and  let  us 
never  cease  our  efforts  until  a  suitable  monument  marks  his 
tomb,  which  should  be  a  "Mecca"  to  us  all. 

I  hope  I  shall  not  be  censured  if  in  imagination  I  linger  too 
long  near  his  shrine,  how  poor  soever  be  the  offering  I  bring  to 
it.    I    suggest  that    a    committee    be  appointed,  as  was  first 

239 


EPHRAiM  McDowell 

proposed  by  my  distinguished  friend,  Dr.  J.  D.  Jackson,  of 
Danville,  to  be  called  the  McDowell  Monument  Committee, 
with  instructions  to  proceed  in  the  most  practical  way  to  raise 
money  for  the  purchase  of  the  monument. 

The  next  record  occurred  In  the  Transactions  of  the 
twenty-first  Annual  Session  of  the  State  Society  held  In 
Hopklnsville  in  the  year  1876. 

According  to  these  records, 

Dr.  L.  S.  McMurtry,  of  Danville,  moved  that  an  Executive 
Committee  be  appointed,  consisting  of  five  members,  to  be 
known  as  the  McDowell  Monument  Committee,  whose  duty  it 
shall  be  to  collect  the  money  already  subscribed  for  that  pur- 
pose, and  secure  such  donations  as  possible,  and  to  erect  some 
monument  over  the  remains  of  Dr.  Ephraim  McDowell,  the 
"Father  of  Ovariotomy,"  at  Danville,  Kentucky. 

The  motion  having  been  seconded,  Doctors  McMurtry  and 
Keller  proceeded  In  a  brief  manner  to  discuss  the  Importance 
of  honoring  the  memory  of  Doctor  McDowell. 

Drs.  J.  H.  Letcher,  J.  L.  Cook,  and  J.  A.  Octerlony  earnestly 
supported  the  measure  embraced  In  the  resolution. 

Something  was  said  about  securing  an  appropriation  from 
our  State  Legislature  for  the  purpose  indicated,  when  Dr.  W.  H. 
Long  remarked  that  he  would  consider  it  a  disgrace  to  Kentucky 
doctors  to  permit  the  Legislature  to  build  a  monument  at 
public  expense  In  honor  to  the  Immortal  McDowell. 

The  motion  of  Doctor  McMurtry  was  unanimously  adopted, 
and  the  chair  appointed  Drs.  L.  S.  McMurtry,  of  Danville; 
J.  H.  Letcher,  of  Henderson;  Turner  Anderson,  of  Louisville, 
H.  M.  Skillman,  of  Lexington,  and  J.  W.  Thompson,  of  Paducah, 
as  members  of  the  McDowell  Monument  Committee. 

The  follow^lng  is  a  transcript  of  the  records  of  the 
Annual  Session  held  in  Louisville,  in  the  year  1877. 

Dr.  Lewis  S.  McMurtry,  of  Danville,  Chairman  of  the  Mc- 
Dowell Monumental  Fund  Committee,  presented  a  verbal 
report  relative  to  the  labors  of  the  committee,  stating  that  their 
work  had  not  been  so  successful  as  was  desired,  but  still  some- 
thing was  being  done  towards  adding  to  the  monumental  fund, 

240 


THE  MOVEMENT  IN  HONOR  OF  HIS  MEMORY 

$434.05  having  been  collected.  But  this  sum,  he  stated,  was 
wholly  inadequate  to  the  purpose  desired.  He  read  a  letter 
from  Dr.  S.  D.  Gross,  of  Philadelphia,  who  urged  that  the 
profession  of  Kentucky  should  subscribe  liberally,  and  who 
protested  against  the  erection  of  a  humble  stone.  The  "  Father 
of  Ovariotomy"  deserved  a  monument  more  imposing  in  its 
character,  and  Dr.  Gross  suggested  that  Europe  be  asked  to 
subscribe,  as  Dr.  McDowell's  fame  was  world-wide. 

Dr.  J.  M.  Keller  stated  that  it  was  not  the  duty  of  the  phy- 
sicians of  Kentucky  to  do  this  work,  but  a  privilege  which  they 
should  gladly  accept,  and  erect  a  shaft  worthy  of  the  great 
name  of  the  dead  surgeon. 

Dr.  John  L.  Cook,  of  Henderson,  favored  the  petitioning 
of  the  legislature  for  aid  in  erecting  a  monument,  as  other  great 
men  had  been  so  honored,  and  there  had  been  none  greater 
than  McDowell. 

Dr.  J.  M.  Bodine  wished  to  know  the  probable  cost  of  erect- 
ing a  suitable  monument. 

Doctor  McMurtry  replied  that  he  had  investigated  the 
subject  but  partially,  yet  supposed  that  $2,500  or  $3,000 
would  be  a  sufficient  sum,  and  that  the  trustees  of  the  Dan- 
ville Cemetery  would  give  a  beautiful  and  eligible  lot  on 
which  to  build  the  monument. 

Doctor  Bodine  thought  Kentucky  physicians  should  do  the 
work  themselves.  He  subscribed  on  the  part  of  the  Medical 
Department  of  the  "University  of  Louisville"  $200,  and  pledged 
himself  to  be  one  of  twenty  persons  to  increase  the  amount  to 
$500,  which  would  be  but  $15  each. 

Other  subscriptions  were  made,  until  the  sum  subscribed 
had  increased  to  more  than  a  thousand  dollars. 

In  the  records  of  the  year  following,  1878,  the  meeting 
being  held  in  Frankfort,  occurs  the  report,  to-wit: 

Dr.  L.  S.  McMurtry,  Chairman  of  the  McDowell  Monu- 
mental Fund  Committee,  made  a  verbal  report,  showing  that 
nearly  one  thousand  dollars  had  been  collected  for  purchasing 
a  monument  to  be  erected  over  the  grave  of  Dr.  Ephraim 
McDowell.  The  same  committee  was  continued  as  an  Execu- 
tive Committee,  and  empowered  to  push  the  work  to  completion. 

16  241 


EPHRAiM  McDowell 

This  brings  us  to  1879,  the  year  of  the  dedicatory 
exercises.    In  the  transactions  of  that  year,  we  find : 

A  motion  that  the  funds  remaining  in  the  hands  of  the 
treasurer  after  payment  of  all  expenses  for  the  year  just 
closed  be  turned  over  to  the  McDowell  Monumental  Fund 
Committee  to  pay  a  deficit  due  on  the  McDowell  monument, 
was  made  by  Dr.  Coleman  Rogers.  Carried,  and  the  treasurer 
accordingly  instructed. 

It  may  be  in  order  at  this  point  to  add  that  the  Com- 
mittee having  the  McDowell  Memorial  Fund  in  charge 
continued  in  existence  until  the  meeting  of  the  following 
year,  held  in  Lexington  in  1880.  At  this  meeting  the 
Committee  was  discharged  after  the  Treasurer,  Dr.  Turner 
-Anderson,  had  read  his  report,  which  was  adopted 
and  filed. 

The  monument  is  described  in  the  Memorial  Pub- 
lication as: 

A  handsome  shaft  made  from  Virginia  granite.  Midway 
on  the  shaft  is  a  bronze  medallion  of  McDowell,  and  beneath 
the  medallion  his  monogram  with  the  motto,  "Honor  to  whom 
honor  is  due."  Upon  the  front  face  of  the  monument  is  the  fol- 
lowing inscription,  encircled  with  a  laurel  wreath:  "A  grateful 
profession  reveres  his  memory  and  treasures  his  example."  On 
the  opposite  side  is  inscribed,  "Erected  by  the  Kentucky  State 
Medical  Society,  1879."  On  the  eastern  face  this  inscription: 
"Beneath  this  shaft  rests  Ephraim  McDowell,  M.D.,  the 
'Father  of  Ovariotomy,'  who,  by  originating  a  great  surgical 
operation,  became  a  benefactor  of  his  race,  known  and  honored 
throughout  the  civilized  world."  The  western  face  is  devoted 
to  the  historic  inscription  as  follows,  being  encircled  with  the 
iEsculapian  serpent:  "Born  in  Rockbridge  County,  Virginia, 
1771;  attended  the  University  of  Edinburgh,  1793;  located  in 
Danville,  Ky.,  1795;  performed  the  first  ovariotomy  1809; 
died  1830." 

Two  accounts  of  the  dedicatory  exercises  which  were 
held  on  May  14, 1879,  are  herewith  appended — the  official 

242 


Memorial  Monument  in  Danville  and  final  burial  spot  of  Dr.  Ephraim 

McDowell  and  Mrs.  McDowell.    Erected  in  1879,  by  the  Kentucky  State 

Medical  Society. 


THE  MOVEMENT  IN  HONOR  OF  HIS  MEMORY 

account  as  it  occurs  in  the  Minutes  of  the  Kentucky  State 
Medical  Society  of  the  year,  1879,  and  an  editorial  com- 
ment in  the  Obstetric  Gazette. 

EVENING    SESSION.       OFFICIAL   ACCOUNT. 

Pursuant  to  adjournment,  the  society  assembled  at  the 
Second  Presbyterian  Church  at  8  o'clock,  where  were  held  the 
formal  exercises  of  unveiling  the  McDowell  Monument.  The 
church  was  filled  to  overflowing  with  a  most  brilliant  and  culti- 
vated audience  of  ladies  and  gentlemen. 

The  chairman  of  the  McDowell  Monumental  Fund 
Committee,  Dr.  Lewis  S.  McMurtry,  Introduced  Professor 
S.  D.  Gross,  M.D.,  LL.D.,  D.C.L.,  Oxon.,  of  Philadelphia,  the 
speaker  of  the  evening,  who  gave  an  interesting  and  accu- 
rate history  of  the  life  of  the  Father  of  Ovariotomy,  Dr. 
Ephralm  McDowell. 

Response  on  the  part  of  the  State  Medical  Society  was  made 
by  Dr.  R.  O.  Cowling,  of  Louisville.  Doctor  Cowling  presented 
Doctor  Gross  with  the  knocker  which  had  hung  upon  Doctor 
McDowell's  door,  which  was  received  with  much  feeling  by  the 
distinguished  gentleman,  whose  expressions  of  thanks  were 
most  eloquent  and  touching,  bringing  tears  to  the  eyes  of 
many  present. 

Dr.  Lewis  A.  Sayre,  of  New  York,  president  of  the  American 
Medical  Association,  was  introduced,  and  made  a  few  appro- 
priate remarks. 

Letters  were  read  from  the  following  distinguished 
gentlemen  who  were  not  able  to  be  present  :  T.  Spencer 
Wells,  Thomas  Bryant,  J.  Knowsley  Thornton,  London;  Oliver 
Wendell  Holmes,  Boston  ;  T.  G.  Richardson,  New  Orleans; 
Theophilus  Parvin,  Indianapolis;  Horatio  R.  Storer,  New- 
port, R.  I.;  T.  Gaillard  Thomas,  New  York,  and  J.  M.  Toner, 
Washington  City. 

Adjourned  to  meet  at  Broadway  Methodist  Church  to- 
morrow morning  9  o'clock. 

Among  the  letters  above  referred  to  there  is  one  by 
Sir  T.  Spencer  Wells,  and  another  by  Oliver  Wendell 
Holmes,  that  deserve  to  be  reprinted. 

243 


EPHRAiM  McDowell 

L.    S.    McMurtry,    M.D.,    Chairman    McDowell    Monument 

Committee : 

Dear  Sir — I  thank  you  very  much  for  your  invitation 
to  attend  the  meeting  connected  with  the  McDowell  Monu- 
ment, and  I  deeply  regret  that  I  am  unable  to  leave  London 
at  present. 

It  would  give  me  extreme  pleasure  to  be  present  at  so  inter- 
esting a  ceremony,  to  make  the  acquaintance  of  so  many  of 
my  American  professional  brethren,  and  to  show  my  respect  to 
the  memory  of  "the  Father  of  Ovariotomy." 

I  shall  hope  in  some  future  year  to  visit  your  great  country 
again,  and  to  see  the  monument  you  have  raised  over  the  grave 
of  McDowell. 

Very  sincerely, 

(Signed)     T.  Spencer  Wells. 

3  Upper  Grosvenor  Street,  London  W., 
April  24,  1879. 

L.    S.    McMurtry,    M.D.,    Chairman    McDowell   Monument 

Committee: 

Dear  Sir — I  regret  that  it  is  not  in  my  power  to  renew  the 
pleasure  of  a  former  visit  to  Kentucky  and  take  part  in  the 
exercises  at  the  dedication  of  the  McDowell  Monument,  at 
least  so  far  as  to  be  a  sympathetic  listener  to  all  the  eloquence 
which  the  occasion  will  call  forth. 

I  feel  a  personal  interest  in  the  surgical  conquest  which  is 
to  be  commemorated  In  addition  to  that  which  all  the  world 
recognizes.  Among  the  births  of  the  century  this  Is  a  twin  with 
myself.  Doctor  McDowell's  first  operation  dates  from  the  same 
year  as  that  in  which  I  first  inhaled  the  slow  poison  that  envelops 
our  planet,  the  effects  of  which  I  have  so  long  survived.  I  thank 
God  that  the  other  twin  will  long  outlive  me  and  my  memory, 
carrying  the  light  of  life  into  the  shadows  of  impending  doom, 
the  message  of  hope  into  the  dark  realm  of  despair;  open- 
ing the  prison  to  them  that  are  bound  and  giving  them  beauty 
for  ashes,  the  beauty  of  a  new-born  existence  even,  it  may 
be,  as  I  have  but  recently  seen  it,  of  youthful  and  happy 
maternity  In  place  of  the  ashes  for  which  the  inevitable  urn 
seemed  already  waiting. 

244 


THE  MOVEMENT  IN  HONOR  OF  HIS  MEMORY 

I  am  glad  that  this  great  achievement  is  to  be  thus  pub- 
licly claimed  for  American  surgery.  Our  transatlantic  cousins 
have  a  microphone  which  enables  them  to  hear  the  lightest 
footsteps  of  their  own  discoverers  and  inventors,  but  they 
need  a  telephone  with  an  ear-trumpet  at  their  end  of  it  to  make 
them  hear  anything  of  that  sort  from  our  side  of  the  water. 
There  is  another  kind  of  trumpet  they  do  not  always  find 
themselves  unprovided  with,  as  those  who  remember  Sir  James 
Simpson's  astonishing  article,  "Chloroform,"  in  the  eighth 
edition  of  the  Encyclopoedia  Britannica,  decently  omitted  and 
ignored  in  the  ninth  edition  of  the  same  work,  do  not  need  to 
be  reminded. 

If  there  was  anyone  who  could  dispute  Doctor  McDowell's 
claim  to  be  called  "the  Father  of  Ovariotomy"  it  would  have 
been  our  own  Dr.  Nathan  Smith — our  own  and  your  own  too, 
for  he  also  was  born  and  lived  and  died  on  the  sunset  side  of  the 
Atlantic,  and  within  the  starry  circle  which  holds  us  all.  Doctor 
Smith  performed  the  operation  of  ovariotomy  with  success  early 
in  the  century,  but  unfortunately  there  is  no  record,  so  far  as  I 
know,  of  the  exact  date.  I  allude  to  this  fact  not  to  invalidate 
Doctor  McDowell's  claim,  for  an  undated  case  can  not  do  it, 
but  to  couple  with  his  name  as  at  least  next  in  priority  that  of 
another  native  American  practitioner  worthy  of  companionship 
with  the  greatest  and  the  best. 

A  single  thought  occurs  to  me  which  may  help  to  give  this 
occasion  something  more  than  professional  significance.  Al- 
though our  political  independence  of  the  mother  country  has 
been  long  achieved,  our  scientific  and  literary  independence  has 
been  of  much  slower  growth. 

And  as  we  read  the  inscription  on  this  monument,  let  us 
gratefully  remember  that  every  bold,  forward  stride  like  this 
grand  triumph  of  American  science,  skill,  and  moral  courage, 
tends  to  bring  us  out  of  the  present  period  of  tutelage  and 
imitation  into  that  brotherhood  and  self-reliance  which  should 
belong  to  a  people  no  longer  a  colony  or  a  province,  but  a  mighty 
nation.    I  am,  dear  sir, 

Yours  very  truly, 

(Signed)     Oliver  Wendell  Holmes. 

Boston,  May  9,  1879. 

245 


EPHRAiM  McDowell 

EDITORIAL   COMMENT.       OBSTETRIC    GAZETTE. 

The  conception  of  this  monument  is  due  to  the  late  Dr.  John 
D.  Jackson,  one  of  Kentucky's  most  accomplished  physicians, 
and  It  seems  sad  that  he  was  not  spared  to  participate  in  the 
completion  of  his  cherished  wish. 

The  oration  was  to  have  been  delivered  by  Dr.  W.  L.  Atlee, 
and  upon  his  death,  Doctor  McMurtry,  Chairman  of  the  Com- 
mittee of  Arrangements,  secured  Dr.  Samuel  D.  Gross,  to  per- 
form this  duty. 

The  dedicatory  exercises  were  held  in  the  Presbyterian 
church,  which  at  an  early  hour  was  closely  packed  with  a  bril- 
liant and  distinguished  assembly.  Doctor  Gross,  occupied  an 
hour  and  a  quarter  in  the  delivery  of  his  oration. 

The  receptions  were  as  follows:  Governor  McCreary  at  the 
Asylum  for  Deaf  and  Dumb,  Dr.  A.  R.  McKee,  Judge  M.  J. 
Durham  and  Dr.  A.  W.  Johnstone. 

We  have  but  one  criticism  to  offer  on  this  memorable  occa- 
sion— and  that  is  not  of  vital  importance — our  Louisville  and 
other  distinguished  Kentucky  gentlemen,  so  completely  cov- 
ered the  ground  that  no  opportunity  was  given  for  the  bubbling 
over  of  those  choice  little  bits  of  impromptu  eloquence  that  some 
of  us  had  so  carefully  prepared  for  the  occasion  and  carried  so 
far  to  dispose  of — but  doubtless  with  a  little  redressing  they 
will  all  answer  for  some  other  dinner  party. 

Although  the  selection  of  Dr.  Samuel  D.  Gross,  it 
seems,  vv^as  not  the  first  choice,  as  the  above  editorial  com- 
ment indicates,  there  Is  hardly  any  room  for  dissenting 
from  the  view  that  he,  above  all  others,  should  have  been 
the  chosen  speaker. 

No  one  else  was  so  well  fitted  and  so  justly  deserved 
this  honor  as  Samuel  D.  Gross.  By  his  memorable  con- 
tribution upon  McDowell  in  his  report  on  surgery  in  the 
second  annual  meeting  of  the  Kentucky  State  Medical 
Society  held  in  Louisville  in  1852,  and  his  consistent  stand 
thereafter  as  McDowell's  defender  and  biographer,  by 
his  interest  as  promoter  of,  and  contributor  to  the  Monu- 

246 


THE  MOVEMENT  IN  HONOR  OF  HIS  MEMORY 

mental  Fund,  he  stood  alone  as  having  labored  more  in 
behalf  of  McDowell  than  any  other  man. 

Washington  L.  Atlee,  although  a  distinguished  ovari- 
otomist,  had  scarcely  any  claim  to  this  honor.  It  was 
largely  Atlee's  premature  expressions,  based  upon  an 
imperfect  knowledge  of  his  subject,  that  did  more  for  a 
time  and  in  a  way  to  obscure  McDowell's  title  to  the 
honor  of  being  the  first  ovariotomist  than  the  expressions 
of  any  other  writer. 

The  English  writers  hardly  omitted  an  opportunity 
to  preface  their  remarks  with  a  reference  to  Atlee,  "the 
American  Ovariotomist"  who  speaks  of  Robert  Houstoun, 
as  the  predecessor  of  McDowell.  Atlee  for  a  time  at 
least,  had  not  only  erroneously  placed  Houstoun,  but  also 
three  others,  as  predecessors  of  McDowell  in  the  per- 
formance of  ovariotomy. 

It  was  the  energetic  defense  which  Gross  so  clearly 
and  forcefully  made  that  removed  all  doubts,  and  so 
plainly  established  the  justice  of  McDowell's  claims,  that 
Atlee  renounced  his  views  by  dedicating  his  work  on 
ovarion  tumors  "To  the  Memory  of  Ephraim  McDowell, 
of  Kentucky,  the  Founder  of  Ovariotomy,  in  1809,"  etc. 
Even  to  this  day  we  hear  echoes  of  Houstoun's  claims. 
These  services,  together  with  the  fact  of  the  long  resi- 
dence of  Doctor  Gross  in  Louisville,  where  for  many  years 
he  taught  so  brilliantly,  and  where  some  of  the  best  of 
his  Hfe's  work  was  done,  or,  as  he  expressed  it,  "which 
had  been  the  most  important  era  in  my  career, "  logically 
made  him  the  speaker  of  the  evening.  The  address  of 
Dr.  Gross,  which  is  a  biography,  a  defense,  a  tribute, 
and  a  history  of  McDowell  and  his  first  ovariotomy,  all 
in  one,  and  is  a  rehearsal  of  his  former  writings  is,  ow- 
ing to  its  length,  scarcely  admissible  here. 

Following   the   memorial    address.     Professor   Gross 

247 


EPHRAiM  McDowell 

was  presented  with  the  door-knocker  from  Doctor 
McDowell's  house,  as  a  token  of  esteem  and  affection 
from  the  profession  of  the  State  of  Kentucky. 

Dr.  Richard  0.  Cowling's  short  presentation  address 
is  such  a  rare  oratorial  gem,  so  full  of  the  tenderest  affec- 
tion, and  so  evidently  sincere  and  appropriate,  that  it  is 
a  pleasure  to  aid  in  its  perpetuation  by  reproducing  it  and 
Doctor  Gross's  reply  in  full  as  they  appear  in  the  Memorial 
publication. 

Presentation  Address 

Doctor  Gross, — ^The  Kentucky  State  Medical  Society 
thanks  you  for  the  beautiful  oration  you  have  just  delivered  on 
Ephraim  McDowell.  Surely  hereafter,  when  history  shall  recall 
his  deeds  and  dwell  upon  his  memory,  it  will  relate  how,  when 
he  was  fifty  years  at  rest,  the  greatest  of  living  surgeons  in 
America  came  upon  a  pilgrimage  of  a  thousand  miles  to  pro- 
nounce at  his  shrine  the  noble  words  you  have  spoken. 

The  society  does  not  wish  that  you  should  return  to  your 
home  without  some  memento  of  the  occasion  which  brought 
you  here,  and  which  shall  tell  you  also  of  the  admiration,  the 
respect,  and  the  affection  it  ever  bears  for  you. 

I  have  been  appointed  to  deliver  to  you  this  simple  gift, 
with  the  trust  and  the  belief  that  it  will  always  pleasantly  recall 
this  time  and  be  a  token  of  our  feelings  toward  you.  We  wished 
to  give  you  something  directly  connected  with  McDowell,  and 
it  occurred  to  us  that  this  memento  of  the  dead  surgeon  would 
be  most  appropriate.  It  is  only  the  knocker  which  hung  upon 
his  door,  but  it  carries  much  meaning  with  it. 

The  sweetest  memories  of  our  lives  are  woven  about  our 
domestic  emblems.  The  hearthstone  around  which  we  have 
gathered,  the  chair  in  which  our  loved  ones  have  sat,  the  cup 
their  lips  have  kissed,  the  lute  their  hands  have  swept — what 
jewels  can  replace  their  value?  Do  you  remember  the  enchant- 
ment that  Douglas  Jerrold  wove  about  a  hat-peg?  How  at  the 
christening  of  the  child  they  gave  it  great  gifts  of  diamonds  and 
pearls  and  laces;  and  when  the  fairy  godmother  came,  and  they 
expected  that  she  would  eclipse  them  all  with  the  magnificence 
of  her  dowry,  how  she  gave  it  simply  a  hat-peg?   They  wondered 

248 


The  McDowell  Door  Knocker.     This  photograph  was  kindly  presented  to  the  author 
by  Mr.  Charles  Perry  Fischer,  Librarian  of  the  College  of  Physicians,  Philadelphia. 


THE  MOVEMENT  IN  HONOR  OF  HIS  MEMORY 

what  good  could  come  of  that.  The  boy  grew  to  be  a  man.  In 
wild  pursuits  his  riches  were  wasted,  and  at  last  he  came  home 
and  hung  his  hat  upon  that  peg.  And  while  the  goodman's  hat 
was  hanging  there  peace  and  plenty  and  order  and  affection 
sprang  up  in  his  home,  and  the  hat-peg  was  indeed  the  talisman 
of  his  life. 

I  would  that  the  magician's  wand  were  granted  me  a  while 
to  weave  a  fitting  legend  around  this  door-knocker,  which 
comes  from  McDowell  to  you,  Doctor  Gross.  There  is  much  in 
the  emblem.  No  one  knows  better  than  you  how  good  and  how 
great  was  the  man  of  whom  it  speaks.  It  will  tell  of  many 
summonses  upon  mercy's  mission  which  did  not  sound  in  vain. 
Ofttimes  has  it  roused  to  action  one  whose  deeds  have  filled  the 
world  with  fame.  A  sentinel,  it  stood  at  the  doorway  of  a  happy 
and  an  honorable  home,  whose  master,  as  he  had  bravely 
answered  its  signals  to  duty  here  below,  so  when  the  greater 
summons  came,  as  trustfully  answered  that,  and  laid  down  a 
stainless  life. 

It  belongs  by  right  to  you,  Doctor  Gross.  This  household 
genius  passes  most  fittingly  from  the  dearest  of  Kentucky's 
dead  surgeons  to  the  most  beloved  of  her  living  sons  in  medicine. 
She  will  ever  claim  you  as  her  son,  and  will  look  with  jealous 
eye  upon  those  who  would  wean  you  from  her  dear  affection. 

And  as  this  emblem  which  now  is  given  to  you  hangs  no 
longer  in  a  Kentucky  doorway,  by  this  token  you  shall  know 
that  all  Kentucky  doorways  are  open  at  your  approach.  By  the 
relief  your  skill  has  wrought;  by  the  griefs  your  great  heart  has 
healed;  by  the  sunshine  you  have  thrown  across  her  thresholds; 
by  the  honor  your  fame  has  brought  her;  by  the  fountains  of 
your  wisdom  at  which  your  loving  children  within  her  borders 
have  drunk,  the  people  of  Kentucky  shall  ever  open  to  you 
their  hearts  and  homes. 

Doctor  Gross's  Reply 

I  am  much  overcome,  gentlemen  of  the  Kentucky  State 
Medical  Society,  by  this  mark  of  your  approbation.  I  am  not 
the  great  man  your  speaker  has  declared  me  to  be,  but  I  grate- 
fully appreciate  the  feelings  that  have  prompted  his  words.  I 
claim  to  be  but  an  earnest  follower  of  surgery,  who  during  a 
period  which  has  now  extended  beyond  half  a  century,  has 

249 


EPHRAiM  McDowell 

striven  to  the  best  of  his  ability  to  grasp  its  truths  and  to  extend 
the  beneficence  of  its  offices.  I  am  not  to  be  placed  by  the  side 
of  McDowell,  for  what  I  may  have  done  in  our  art;  but  if  this 
reward  be  a  measure  of  the  appreciation  I  hold  of  the  good-will 
of  the  people  in  this  Commonwealth,  I  may  claim  it  for  that. 

The  years  of  my  life  which  I  passed  in  Kentucky  represent 
the  most  important  era  in  my  career.  They  witnessed  many  of 
its  struggles  and  much  of  the  fruition  of  its  hopes.  To  the  warm 
hearts  of  the  many  friends  it  was  my  good  fortune  to  secure 
within  these  borders  do  I  owe  it  that  those  struggles  were  cheered 
and  rewards  beyond  my  deserts  were  secured. 

I  take  this  emblem  now  offered  me  as  the  most  valued  gift 
of  my  life.  It  shall  be  received  into  my  home  as  a  household 
god,  environed  by  all  the  memories  of  goodness  and  greatness 
to  which  your  speaker  has  referred,  and  above  all  recalling  this 
scene.  Dying  I  shall  bequeath  it  among  my  most  important 
possessions  to  the  family  that  I  may  leave,  or  in  failure  of  that, 
to  be  preserved  in  the  archives  of  some  society. 

I  thank  you  again,  gentlemen,  and  I  wish  I  were  able  to  tell 
you  better  how  much  I  thank  you. 

The  ceremonies  represented  a  creditable  beginning  in 
a  most  worthy  cause,  but  with  two  such  speakers  as  Sam- 
uel David  Gross  and  Richard  Oswald  Cowling,  it  could 
hardly  have  been  otherwise. 


250 


CHAPTER  XII 

THE    CENTENNIAL    CELEBRATION    OF    THE    FIRST    OVARIOTOMY 

EFFORTS     TO     MEMORIALIZE     THE      McDOWELL  HOUSE THE 

author's  ADDRESS  BEFORE   THE   KENTUCKY   STATE  FEDERA- 
TION  OF    women's  clubs. 

Following  these  memorial  exercises,  all  interest  and 
effort  in  this  direction  seem  to  have  subsided  until  1909, 
the  hundredth  anniversary  of  the  first  ovariotomy.  In 
this  year,  after  a  lapse  of  three  decades,  we  note  a  revival 
of  interest  in  McDowell,  that  took  the  form  of  centennial 
exercises  in  commemoration  of  the  first  ovariotomy. 
The  operation  had  by  this  date  passed  through  the 
test  of  a  century's  experience,  or,  more  accurately  speaking, 
the  vicissitudes  of  a  century,  an  ample  period  in  which 
to  reach  something  like  a  final  conclusion  as  to  its  direct 
and  indirect  benefits,  both  of  which  had  by  this  time  far 
exceeded  the  most  extravagant  expectations.  It  would 
not  have  been  unreasonable,  therefore,  to  have  expected 
a  celebration  commensurate  with  the  dignity  and  the  real 
importance  of  the  work  of  McDowell,  and  the  full  signifi- 
cance of  his  first  ovarian  operation. 

Unfortunately  such  was  not  the  case.  This  centenary 
event  should  have  aroused  a  widespread  enthusiasm  that 
would  have  resulted  in  action  appropriately  honoring  the 
memory  of  a  super-member  of  our  profession.  But  as  it 
not  infrequently  happens,  we  were  too  much  absorbed  in 
our  own  plans;  we  were  so  completely  under  the  dominion 
of  our  own  personal  interest  that  we  seemed  to  have 
neither  time  nor  inclination  to  stop  long  enough  or  to 
manifest  interest  enough  to  honor  one  of  our  members 
who  had  done  so  much  for  the  human  race,  and  who  had 

251 


EPHRAiM  McDowell 

made  it  directly  possible  for  us  to  perpetuate  his  benefits, 
and  incidentally  enrich  ourselves. 

The  great  organizations  of  medicine  and  their  leaders, 
who  have  the  attention  of  the  profession,  overlooked  a 
wonderful  opportunity  to  encourage  and  foster  the  spirit 
of  appreciation  and  gratitude  for  one  who  did  so  much  to 
make  our  careers  distinguished,  not  to  mention  the  far 
greater  benefits  to  the  world  in  general. 

The  only  efforts  in  this  direction  that  came  to  our 
attention  were  those  of  the  American  Gynecological 
Society  in  New  York,  and  of  the  McDowell  Medical 
Society  in  Cincinnati.  It  is  obvious  that,  if  it  fell  to  the 
lot  of  any  particular  society  to  take  up  this  task,  that 
society  should  be  the  American  Gynecological  Society,  for 
without  McDowell  there  would  scarcely  be  any  excuse 
for  the  existence  of  such  a  society.  We  say  this  not  in  a 
limited  sense,  because  he  was  the  first  ovariotomist,  but 
broadly,  because  the  first  ovariotomy  was  really  the  be- 
ginning of  abdominal  and  pelvic  surgery.  For  this  reason 
we  feel  that  the  obligation  of  adequately  honoring  the 
memory  of  McDowell  did  not  fall  exclusively  to  the  Ameri- 
can Gynecological  Society,  but  became  the  logical  duty  of 
at  least  the  entire  division  of  surgery  if  not  the 
whole  profession. 

Some  day  we  hope  that  the  whole  medical  profession 
will  realize  the  debt  it  owes  this  hero,  to  whom  it  has 
accorded  such  scant  recognition,  and  will  then  take  the 
lead  in  arousing  humanity  to  the  step  of  finally  honoring 
Ephraim  McDowell,  as  it  should  have  done  long  since. 
It  would  be  ungracious,  indeed,  not  to  recognize  fully 
the  credit  due  the  American  Gynecological  Society  for  its 
centennial  celebration,  yet  it  would  also  be  an  error  to 
overlook  some  of  the  opportunities  that  were  lost  upon 
that  occasion. 

252 


CENTENNIAL  CELEBRATION,  FIRST  OVARIOTOMY 

It  is  a  matter  of  regret  that  the  committee  in  charge 
of  the  celebration  decided  upon  holding  the  exercises  in  a 
fashionable  hotel  in  New  York  City,  instead  of  in  Dan- 
ville, Ky.  It  would  have  been  so  much  more  appropriate 
to  have  held  these  services  in  Danville,  the  scene  of 
McDowell's  activities,  the  hallowed  spot  where  this  im- 
mortal operation  was  consummated,  than  to  select  a 
rich,  but,  after  all,  commonplace  hotel,  where  there  was 
all  the  food  and  finery  that  money  can  buy,  but  none  of 
the  spiritual  relationship  which  is  the  soul  of  such  a 
gathering,  and  which  supplies  the  inspiration  and  excuse 
for  such  a  celebration.  It  would  have  been  better  to  have 
followed  the  splendid  example  which  the  English  gave  us 
in  erecting  a  Memorial  Theatre  in  the  charming  little  town 
of  Stratford — a  town  not  unlike  Danville  in  size.  There 
memorial  performances  are  given  in  honor  of  the  immortal 
Shakespeare.  With  this  example  before  us,  would  it  be 
asking  too  much  to  expect  a  society  whose  work  is  so 
inseparably  blended  with  the  accomplishments  of  Mc- 
Dowell, and  so  dependent  upon  them,  once  in  a  hundred 
years  to  make  a  pilgrimage  to  this  shrine ? 

It  is  true  that  the  little  town  of  Danville  did  not  have 
the  pretentious  hotel  that  the  American  metropolis 
afforded,  but  it  had  something  better,  an  adequate 
number  of  splendid  homes  surcharged  with  genuine 
Kentucky  hospitality.  This  would  have  made  the  gather- 
ing less  formal,  and  aside  from  the  chief  aim  in  view, 
would  have  been  to  those  accustomed  to  large  cities 
more  unique  and  impressive  than  the  brilliant,  but  not 
at  all  distinctive  performance  in  New  York  City.  To 
this  should  be  added  the  historic  interest  in  which  Dan- 
ville abounds,  an  interest  which  does  not  stop  with  the 
performance  of  the  first  ovariotomy,  indirectly  the 
birth  of  abdominal  surgery. 

253 


EPHRAiM  McDowell 

The  fate  of  our  country  for  a  time  after  the  Revolution 
was  about  as  dependent  upon  the  events  and  the  spirit 
that  prevailed  in  Danville  as  it  was  upon  the  action  that 
was  going  on  in  the  Federal  City,  as  Washington  was 
then  known.  The  indefinite  state  of  the  relations  that 
existed  at  the  close  of  the  Revolutionary  War  between 
our  young  republic  and  Great  Britain,  and  the  continued 
existence  of  armed  British  outposts,  together  with  the 
Indians,  in  a  region  that  was  still  claimed  by  both  govern- 
ments, made  Danville  a  point  of  the  utmost  strategic 
importance  and  the  scene  of  no  small  amount  of  inter- 
national intrigue. 

McDowell  was  not  the  only  citizen  who  added  interest 
and  color  to  this  historic  township,  and  whose  name  has 
passed  into  history.  There  were  others  of  less,  but  still 
enduring  fame.  Among  them  were  John  James  Audubon, 
the  naturalist;  Joseph  Hamilton  Daviess,  who  arraigned 
Aaron  Burr  for  treason,  and  was  the  first  United  States 
District  Attorney;  Keane  O'Hara,  the  village  school- 
master and  the  father  of  Theodore  O'Hara,  the  author  of 
"The  Bivouac  of  the  Dead."  The  ancestors  of  James 
Gillespie  Birney  lived  here,  and  were  related  to  the 
McDowells.  Birney  was  the  first  Abolitionist  candidate 
for  the  presidency  in  1844.  According  to  Dr.  Fayette 
Dunlap,  one  brother  of  Birney  was  minister  to  The  Hague, 
another,  professor  of  English  literature  in  the  University 
of  Paris,  and  a  third,  a  professor  of  engineering  in  our 
MiKtary  Academy  at  West  Point. 

These  various  attractive  and  logical  reasons  in  favor 
of  Danville,  together  with  the  information,  which  we  re- 
ceived from  a  most  reliable  source,  that  the  extension  of 
an  invitation  had  not  been  overlooked  by  Danville,  should 
be  a  sufficient  apology  for  the  consideration  of  the  short- 
comings of  this  celebration. 

254 


CENTENNIAL  CELEBRATION,   FIRST  OVARIOTOMY 

From  the  thirty-fourth  volume  of  the  Transactions 
of  the  American  Gynecological  Society,  pubHshed  in 
the  year  1909,  we  copy  the  following  relative  to  these 
memorial  exercises. 

Facing  page  eleven  is  an  illustration  of  two  gavels;  the 
title  under  the  upper  one  is  as  follows  : 

Inscription  on  the  shaft  of  the  gavel.  Doorknob  from  the 
office  of  Ephraim  McDowell.  Presented  to  the  American  Gyne- 
cological Society  by  T.  A.  Ashby,  M.D.,  of  Baltimore. 

Inscription  on  the  handle  of  the  lower  gavel.  Wood  from 
house,  A.  Dunlap,  1843.  Inscription  on  the  head  of  lower  gavel. 
Presented  to  the  American  Gynecological  Society  by  W.  P. 
Manton.  McDowell  centennial,  New  York,  1909.  Wood  from 
house  of  Ephraim  McDowell,  1809. 

The  bronze  McDowell  memorial  medallion  presented  to 
each  Fellow  and  guest  at  the  dinner  given  in  commemoration  of 
the  first  Ovariotomy  by  Dr.  Ephraim  McDowell.  The  medallion 
is  two  and  three  quarter  inches,  showing  on  the  obverse  the  pro- 
file of  the  great  surgeon,  with  the  inscription,  "To  commemorate 
the  First  Ovariotomy,  1 809-1909,  Ephraim  McDowell."  The 
reverse  is  the  seal  of  the  Society. 

The  medallion  was  designed  and  modelled  by  a  Fellow 
of  the  Society,  Dr.  Robert  L.  Dickinson,  of  Brooklyn,  and 
cast  by  Gorham. 

Reproduction  of  invitation  to  Ephraim  McDowell's 
Centennial: 

1809.        E.  McD.        1909. 

(Monogram) 

Dinner  in  commemoration  of  the 

First  Ovariotomy  by 

Doctor  Ephraim  McDowell, 

given  by 

The  New  York  and  Brooklyn  Fellows  of  the 

American  Gynecological  Society 

on  Thursday,  the  twenty-second  of  April, 

One  thousand  nine  hundred  and  nine, 

Waldorf  Astoria, 

New  York. 

255 


EPHRAiM  McDowell 

Banquet  Program 
Speakers 

Ephraim  McDowell,  the  First  Ovariotomist,   Lewis  S.  Mc- 

Murtry,  M.D.,  Louisville,  Ky. 
Lantern  Slide  Pictures,  E.  C.  Dudley,  M.D. 
Mrs.  Crawford:   A  Type  of  American  Womanhood,  Edward  P. 

Davis,  M.D.,  Philadelphia. 
McDowell's  Successors  in  America,  Howard  A.  Kelly,  M.D. 
McDowell's    Successors    in   the   British   Empire,    Herbert   R. 

Spencer,  M.D.,  F.R.C.P.,  London. 
McDowell's  Successors  in  France,  Professor  S.  Pozzi,  Paris. 
McDowell's    Successors    in    Germany,    Professor    Hofmeier, 

Wiirzburg. 

The  addresses  at  the  banquet  consisted  largely  of  a 
revlewal  in  a  concise  manner  of  the  data,  historical  and 
otherwise,  Indicated  in  their  titles.  There  was  one  note  In 
all  this  discourse  that  Is  worthy  of  repetition.  It  Is  the 
suggestion  of  Dr.  Herbert  R.  Spencer,  who  represented 
the  British  Empire,  when  he  said: 

In  the  beautiful  park  of  this  city  where  voyagers  from  the 
Old  World  land  in  the  New,  I  would  like  to  see,  side  by  side 
with  those  erected  to  Shakespeare,  Scott  and  Burns,  a  monument 
inscribed  Ephraim  McDowell,  with  no  record  of  his  work,  which 
is  a  monumentum  aere  -perennius.  In  this  meeting,  raised  a 
hundred  yards  above  the  level  of  the  pavement  and  a  hundred 
years  above  the  level  of  the  past,  he  needs  no  monument  of 
moulded  bronze  or  sculptured  stone.  The  visitor  to  St.  Paul's 
Cathedral  looks  in  vain  for  any  ^'Ss.^y  of  Wren,  its  great  archi- 
tect, but  is  told  if  he  requires  a  monument,  to  look  around; 
and  so  I  say  to  this  great  meeting  of  American  gynecologists, 
*'St  monumentum  requiris  circumspice.^^ 

The  other  centenary  celebration  of  the  first  ovari- 
otomy occurred  In  Cincinnati,  under  the  auspices  of  the 
McDowell  Medical  Society  of  that  city.  This,  like  the 
foregoing,  was  in  the  form  of  a  banquet.  The  two  prin- 
cipal speakers  were  Dr.  Samuel  Gary  Swartsel,  whose 

256 


CENTENNIAL  CELEBRATION,   FIRST  OVARIOTOMY 

subject  was  "Ephraim  McDowell,"  and  Dr.  Fayette 
Dunlap,  a  native  of  Danville,  whose  subject  was  "Pioneer 
Days  in  the  Blue  Grass." 

If  there  was  anywhere  else  any  other  recognition  of 
the  hundredth  anniversary  of  this  epoch-making  step  in 
medicine,  it  has  escaped  our  observation.  Likewise,  if 
there  were  any  other  efforts  made  either  before  or  after 
the  centenary  celebration  with  the  view  of  memorializ- 
ing in  one  way  or  another  the  life  and  labors  of 
McDowell,  we  are  not  aware  of  them. 

Our  own  efforts  in  this  direction  are  the  outcome  of  the 
inquiry  that  had  its  origin  in  Berlin,  when  the  question 
was  asked  whether  McDowell  did  his  first  ovariotomy 
upon  a  negress,  as  was  then  believed  in  Germany,  and  to  a 
great  extent  is  still  believed  there  and  very  likely  in  other 
parts  of  Europe.  This  inquiry  actively  began  about  the 
middle  of  the  summer  of  191 1.  One  of  our  first  steps  was 
to  make  an  investigation  of  matters  relating  to  McDowell, 
as  they  then  existed  in  Danville.  Our  first  visit,  although 
necessarily  of  short  duration  and  in  the  nature  of  a  recon- 
noitre, was  sufficient  to  reveal  plainly  the  utter  neglect 
into  which  the  landmarks  associated  with  this  hero 
had  fallen. 

So  far  as  appearances  went,  he  seemingly  meant  no 
more  to  Danville  than  hundreds  of  others  who  have  lived 
there  without  adding  anything  out  of  the  ordinary  to  the 
common  interest  in  humanity.  In  a  way  he  was  still  an 
asset  to  the  community,  without  the  community's  appar- 
ently realizing  its  corresponding  obligation.  The  interest 
in  the  landmarks,  notably  his  house  and  office  where  the 
operation  was  most  likely  performed,  was  one  of  mingled 
curiosity  .  and  vandalism.  The  landmarks  were  of  suffi- 
cient importance  to  become  the  subject  of  one  of  the 
most  interesting  of  their  illustrated  postcards,  but  not 

17  257 


EPHRAiM  McDowell 

important   enough   to   be   rescued  from  the  ignominious 
fate  of  a  negro  "rooming  house." 

The  esteem  in  which  this  house  is  held  at  present  can 
best  be  judged  by  a  passage  from  a  letter,  received  from 
one  of  the  highly  respected  practitioners  of  Danville, 
when  he  says  in  answer  to  a  particular  question  pertaining 
to  this  house:  "I  drove  slowly  by  the  place,  by  the  resi- 
dence and  carefully  scanned  it."  .  .  .  "The  occupancy  of 
these  structures  being  somewhat  disagreeable  I  did  not 
seek  an  entrance  to  the  rear,  to  examine  the  west  side." 

We  shall  never  forget  this  first  visit.  Although  we 
were  in  a  way,  conversant  with  the  existing  conditions, 
we  were  not  prepared  to  encounter  the  degree  of  neglect 
that  met  our  gaze. 

Unless  one  sees  it  one  can  hardly  realize  how  a  structure 
that  should  mean  so  much  could  sink  to  such  a  state  in 
so  enhghtened  a  community,  and  under  the  very  shadow 
of  an  institution  of  learning  like  Centre  College,  of  which 
Ephraim  McDowell  was  one  of  the  founders  and  first 
trustees.  And  if  one  goes  but  a  few  steps  farther  and  finds 
the  first  capital  of  the  state,  in  which  no  small  amount  of 
history  was  created,  in  a  similar  condition,  his  astonish- 
ment becomes  complete. 

A  piece  of  silver  paved  the  way  for  an  entree  to  every 
nook  and  corner,  but  the  grimy  state  in  which  we  found 
most  of  the  building  defies  all  powers  of  description. 
As  we  reached  the  third  floor,  which  was  in  the  form 
of  an  attic,  our  Amazonian  conductress  grasped  the  rem- 
nant of  a  facing  and  bracing  herself  with  her  foot  against 
the  wall,  began  to  tear  this  loose.  When  we  asked  her  what 
she  was  trying  to  do,  she  rephed  in  her  best  Ethiopian 
dialect,  "Ise  fixin  to  git  ah  suveneeh  fah  yu,"  and  when 
we  informed  her  that  we  did  not  want  a  souvenir  and  that 
we  were  interested  in  preserving  rather  than  destroying 

258 


CENTENNIAL  CELEBRATION,  FIRST  OVARIOTOMY 

the  house,  she  said  in  surprise  "Wha,  evah  body  gits  ah 
suveneeh  what  comes  heah!" 

In  view  of  this  disclosure  our  first  thought  was  to 
correct  this  neglect,  and  save,  if  possible,  before  it  is  too 
late,  this  precious  landmark.  Like  others  before  us, 
among  whom  are  J.  D.  Jackson,  Ely  McClelland  and 
J.  W.  Thompson,  the  most  natural  and  logical  thought 
that  suggested  itself  was  to  appeal  to  the  women  of  the 
state.  The  women  were  the  first  to  enjoy  the  fruits  of 
McDowell's  labors,  and  for  that  reason  it  was  but  common 
gratitude  for  them  to  lead  in  the  efforts  to  rescue  this  shrine. 
Aside  from  this,  in  matters  pertaining  to  civic  better- 
ment, the  preservation  of  historic  landmarks,  and  the 
esthetic  side  of  a  city,  we  involuntarily  think  of  the 
influence  which  the  women  have  wielded,  and  will  no  doubt 
in  an  increasing  degree  continue  to  wield. 

Other  methods  of  procedure  were  not  overlooked, 
among  which  was  bringing  the  matter  before  the  medical 
profession  of  the  state.  This  idea,  as  we  had  learned 
through  experience  on  more  than  one  occasion,  had  its  un- 
favorable as  well  as  its  favorable  side,  and  for  this  and  the 
foregoing  reasons  we  concluded  to  begin  the  task  by  appeal- 
ing to  the  Kentucky  State  Federation  of  Women's  Clubs 
as  the  most  appropriate  medium  through  which  to  operate. 
Before  mentioning  the  subject  to  the  Federation,  it  was 
important  to  secure,  if  possible,  an  option  upon  the 
property,  thus  allowing  a  freedom  of  action  provided  it 
received  the  approval  and  the  co-operation  of  the 
Federation. 

This  was  the  first,  and  as  matters  progressed,  the  only 
difficulty  to  be  overcome.  Unfortunately  it  remained  the 
first,  the  last,  and  the  only  difficulty  that  could  not  be  over- 
come. Having  in  a  quiet  way  become  familiar  with  some 
of  the  possible  difficulties,  we  proceeded  carefully,  and, 

259 


EPHRAiM  McDowell 

in  the  beginning,  secretly,  to  acquire  this  option  personally. 
In  doing  so,  we  took  into  our  confidence  Mr.  John  A. 
Quisenberry,  a  banker  of  Danville,  who  sympathetically 
Hstened  to  our  plans,  and  although  somewhat  doubtful  of 
the  feasibility  of  the  step,  earnestly  and  sincerely  co- 
operated with  us  in  this  difficult  enterprise.  The  one 
difficulty  and  the  only  difficulty  that  was  apparent  from 
the  beginning,  and  that  became  more  and  more  evident  as 
we  proceeded,  was  that  of  reaching  a  somewhat  reasonable 
agreement  with  the  owner  of  the  building.  For  certain 
reasons  it  was  deemed  best  to  approach  him  through  a 
third  person,  one  who  was  known  rather  as  a  purchaser 
of  negro  property  than  of  historic  landmarks.  This  third 
person,  however,  was  not  aware  of  our  plans,  yet  as  di- 
rected he  began  to  secure  an  option  if  possible,  or  failing 
in  this,  to  extract  from  the  owner  a  statement  as  to  the 
figure  at  which  he  was  willing  to  sell.  Although  not 
definitely  knowing  at  that  time  who  eventually  would 
supply  the  funds,  we  were  ready  and  willing  to  step  in  and 
personally  acquire  the  property,  if  a  reasonable  price 
could  be  decided  upon.  This  would  have  simplified  mat- 
ters at  once. 

The  time  that  remained  until  the  meeting  of  the  Fed- 
eration, at  which  the  proposition  was  for  the  first  time  to 
be  made  public,  was  a  matter  of  few  weeks,  short  in  a 
way,  but  quite  sufficient  for  us  to  have  reached  a  con- 
clusion several  times  over,  if  there  had  been  any  disposi- 
tion on  the  part  of  the  owner  to  sell  at  a  reasonable  figure. 
After  every  personal  effort  had  been  exhausted,  and  as  the 
time  for  the  annual  meeting  of  the  Kentucky  Federation 
of  Women's  Clubs  was  approaching,  steps  were  taken  to 
extend  the  campaign.  Since  the  individual  efforts  had 
failed,  we  decided  to  come  into  the  open,  as  any  other 
course   much    longer    continued   would   have    been    an 

260 


CENTENNIAL   CELEBRATION,   FIRST  OVARIOTOMY 

injustice  to  the  public,  who  should  not  be  denied  the 
opportunity  of  co-operating  in  such  a  movement,  if  they 
so  desired. 

The  project  was  brought  to  the  attention  of  the  Presi- 
dent of  the  Kentucky  Federation  of  Women's  Clubs,  who 
was  quick  to  realize  the  propriety  of  bringing  the  subject 
before  that  body,  and  the  importance  of  prompt  action. 

We  were  invited  to  present  the  matter  personally 
before  the  Federation  at  its  annual  meeting,  which  was 
held  at  Mammoth  Cave  on  May  28,  29,  and  30,  1912. 

This  we  did  in  the  following  address: 

An  Appeal  to  the  State  Federation  of  Women's 
Clubs  to  Memorialize  the  McDowell  Building 
AT  Danville. 

By  August  Schachner,  M.D. 

Madame  President  and  Ladies  of  the  State  Federation  of 
Women's  Clubs: 

The  most  interesting  side  of  Europe  is  the  historical, 
and  in  the  comparative  absence  of  history,  we  differ 
perhaps  most  widely  from  Europe.  That  Europe  has 
such  an  interesting  historical  side,  is  due  to  her  age  on 
the  one  hand,  and  equally  so  to  a  carefully  developed 
and  deeply  rooted  sentiment  on  the  other  hand. 

They  have  a  commendable  reverence  for  the  historical 
that  is  at  one  and  the  same  time  an  index  to  their  past 
and  present  culture,  and  a  source  of  revenue  by  reason  of 
its  influence  upon  the  tourists.  Opulent  as  we  are,  our 
opulence  cannot  gain  us  any  history.  History  cannot  be 
bought,  but  must  be  created,  and  for  its  creation,  time, 
although  not  the  only  factor,  is  yet  the  most  essential 
element  in  its  development. 

With  us  the  spirit  of  commercialism  overshadows 
everything.     In  our  struggle  for  commercial  supremacy, 

261 


EPHRAiM  McDowell 

we  overlook  to  too  great  a  degree  the  higher  side  of  a 
national  life,  prominent  in  which  is  the  historical.  Unless 
we  develop  an  interest  in  the  historical  side  and  keep  this 
interest  alive  as  we  go  along,  we  shall  some  day  awaken  to 
the  sad  fact  that  our  finest  gems  have  unconsciously 
slipped  through  our  fingers  to  be  lost  now  and  for  all 
time  to  come.  Or,  what  may  be  more  humiliating  will 
be  that  a  disappointed  posterity  will  point  the  finger  of 
scorn  at  us  for  our  short-sighted  indiiFerence  in  these 
important  matters. 

An  excellent  illustration  of  this  truth  we  have  in  the 
house  of  Dr.  Ephraim  McDowell  in  Danville.  This 
historic  shrine  at  present  is  reduced  to  the  ignominious 
fate  of  a  negro  boarding-house. 

If  benefit  to  the  human  race  is  to  be  the  standard  by 
which  we  measure  the  usefulness  and  importance  of  a  life, 
I  am  prepared  to  defend  the  statement  that  the  importance 
of  Dr.  Ephraim  McDowell's  Hfe  overshadows  that  of  either 
Washington  or  Lincoln,  and  that  the  house  in  Danville, 
in  which  the  first  ovariotomy  was  performed,  should  be 
more  sacred,  not  only  to  the  American,  but  to  the  entire 
human  race,  than  any  other  structure  upon  the  whole 
American  continent. 

It  has  been  fashionable  for  centuries  to  ignore  the  real 
benefactors  of  the  human  race,  and  to  rush  madly  forward 
with  monuments  and  memorials  to  statesmen  and  espe- 
cially military  leaders.  This  is  a  remnant  of  the  feudalism 
that  is  still  in  us.  It  is  a  legacy  from  the  time  when 
might  was  right,  even  in  smaller  matters,  as  it  still  is  to 
a  degree  in  international  matters,  when  we  more  fondly 
than  we  do  to-day  worshipped  pomp  and  power  at  the 
expense  of  equity  and  reason.  I  do  not  wish  to  be  under- 
stood as  detracting  from  the  statesman  and  the  warrior, 
but  I  do  wish  to  point  out  the  benefits  of  the  work  of  such 

262 


CENTENNIAL  CELEBRATION,   FIRST  OVARIOTOMY 

a  man  as  Ephraim  McDowell  as  compared  with  that  of 
the  very  greatest  statesmen  and  miHtary  leaders.  The 
molding  of  a  nation,  the  advancement  of  a  particular 
people  by  a  wise  statesman,  and  the  leadership  of  a  suc- 
cessful army  in  a  just  cause  are  matters  that  do  not 
admit  of  any  division  of  opinion.  Since,  however,  many 
statesmen  are  forcible  but  not  wise,  and  many  military 
leaders  brave  and  daring  in  an  unjust  cause,  as  well  as  a 
just  cause,  it  is  obvious  that  both  harm  and  good  are 
equally  dispensed  by  these  two  popular  idols.  And  even 
when  the  statesman  is  wise,  and  the  military  leader  is 
fighting  a  just  cause,  they  affect  but  one  people,  and  the 
effect  is  perhaps  for  one  period,  quite  enough  to  justify 
their  activities,  I  will  admit,  as  we  all  must.  Compare, 
however,  this  Ephraim  McDowell,  whose  life  has  affected 
all  people  for  all  times  and  in  the  most  important  man- 
ner, since  his  work  deals  not  with  the  fortunes  of  his  fellow- 
men,  but  with  their  very  lives. 

When  Ephraim  McDowell,  on  December  13,  1809, 
performed,  before  the  time  of  anaesthetics,  and  without 
trained  assistants,  and  the  usual  conveniences  that  to-day 
are  considered  as  almost  indispensable,  for  the  first  time, 
the  operation  of  ovariotomy,  or  the  removal  of  an  ovarian 
tumor,  he  conferred  upon  womanhood  in  particular,  and 
mankind  in  general,  a  benefit  as  great  as  any  that  has 
ever  been  conferred  upon  the  human  race  in  this  or  any 
other  country,  and  in  this  or  any  other  age.  It  meant 
rescuing  in  time  to  come,  millions  of  women  from  a  period 
of  suffering  and  invalidism  from  which  at  that  time 
death  alone  was  the  only  avenue  of  escape. 

I  am  sure  that  no  one  will  for  a  moment  dispute  the 
magnitude  of  this  service  to  humanity,  but  I  am  not  sure 
as  to  how  many  of  us  can  really  measure  the  magnitude 
of  this  deed.    Immeasurable  as  its  importance  in  itself  is, 

263 


EPHRAiM  McDowell 

in  the  course  of  time  it  has  proved  to  be  the  cornerstone 
of  the  entire  domain  of  abdominal  surgery. 

Since  the  women  were  the  first,  and  perhaps  are  still 
the  chief  beneficiaries  of  his  work,  it  seems  entirely  natural 
for  the  women  of  Kentucky  to  rescue  the  house  in  which 
this  memorable  deed  was  performed,  which  has  added  to 
the  honor  and  glory  of  Kentucky  more  than  all  her  other 
achievements  combined,  great  as  they  are. 

When  this  is  accomplished,  there  should  be  a  national 
or  an  international  movement  to  erect  a  monument  be- 
fitting such  services,  to  the  memory  of  Dr.  Ephraim 
McDowell,  of  Danville,  and  Mrs.  Crawford,  of  the  County 
of  Green,  in  the  State  of  Kentucky,  the  first  woman  who 
submitted  to  the  operation. 

Doctor  McDowell  has  been  more  than  ordinarily  neg- 
lected, although  the  Kentucky  State  Medical  Association 
did  erect  in  the  year  1879  a  monument  at  Danville  to 
his  memory.  But  Mrs.  Crawford,  to  whom  common 
justice  should  accord  honor  and  glory  equal  in  degree  to 
that  of  Doctor  McDowell,  as  suggested  by  Dr.  Lewis  A. 
Sayre  over  thirty  years  ago,  for  her  courage  and  heroism 
in  risking  her  life  to  have  the  experiment  tried  for  the 
first  time,  has  suffered  even  more  neglect.  We  do  not 
know  her  full  name.  We  have  no  picture  of  her.  We  only 
know  that  she  was  forty-seven  years  of  age  at  the  time  of 
the  operation,  and  lived  thirty-two  years  after  the  opera- 
tion; that  she  came  from  Green  County  some  sixty  miles 
from  Danville,  and  returned  in  twenty-five  days  as  she 
came,  on  horseback,  free  of  her  immense  tumor  and 
entirely  unconscious  of  her  future  fame. 

I  am  here  to  make  an  appeal  to  you  to  unite  in  rescuing 
from  oblivion  what  should  be  the  most  cherished  and 
sacred  structure  in  the  entire  republic.  Even  though  the 
house  should  by  some  misfortune  be  destroyed,  the  spot 

264 


CENTENNIAL  CELEBRATION,   FIRST  OVARIOTOMY 

should  be  memorialized.  Considering  the  fact  that 
throughout  the  world  hundreds  of  thousands  of  abdominal 
operations  are  performed  every  year,  with  more  than  nine- 
tenths  of  the  patients  recovering,  and  that  this  will  con- 
tinue indefinitely,  one  feels  like  saying  that  it  would  be 
akin  to  savagery  to  ignore  the  spot  where  this  deed,  im- 
measurable for  its  good,  was  consummated. 

In  closing,  I  desire  to  present  for  your  consideration: 
First,  that  the  women  of  Kentucky  pledge  themselves  to 
buy  at  a  fair  valuation,  this  historic  structure  without  any 
unnecessary  delay,  and  memorialize  it  as  is  the  custom  in 
all  the  older  countries  under  such  condition;  Second,  I 
would  suggest  the  appointment  of  a  committee  with  a 
member  with  full  power  to  act  in  each  Congressional 
district,  to  begin  raising  funds  as  soon  as  the  preliminary 
steps  towards  securing  the  property,  are  settled.  I 
would  consider  it  an  honor  indeed  to  assist  by  doing 
all  in  my  power  to  help  bring  about  the  successful  issue 
of  the  project. 


265 


CHAPTER  XIII 

REVIEW   OF   THE    CORRESPONDENCE   AND    EFFORTS   TO    PURCHASE 

THE    HOUSE DESCRIPTIVE   TEXT   OF   THE    GROUND    PLAN    OF 

THE    MCDOWELL    HOUSE. 

The  idea  was  enthusiastically  received,  and  as  a  result 
the  following  resolution  was  incorporated  in  the  Federa- 
tion's working  plan  for  the  ensuing  year: 

Resolved,  That  the  K.  F.  W.  C.  co-operate  with  Dr.  August 
Schachner,  in  raising  a  memorial  to  Dr.  Ephraim  McDowell, 
by  preserving  the  home  of  Dr.  McDowell  at  Danville,  Ky.,  as 
a  museum  in  memory  of  his  skill  and  the  courage  of  Mrs.  Craw- 
ford, who  submitted  to  the  first  ovariotomy. 

A  committee  was  created  under  the  name  of  the 
McDowell  Memorial  Committee,  and  I  was  requested  to 
become  the  financial  secretary.  Difficult  as  the  task 
was,  we  entered  upon  it  with  all  the  earnestness  at 
our  command.  Our  work  fell  into  two  divisions.  The 
first  consisted  of  securing  the  funds  and  the  second 
of  purchasing,  if  possible,  the  property.  Although  the 
idea  was  enthusiastically  received,  when  the  real  test 
came,  as  it  not  infrequently  happens,  the  enthusiasm  died 
almost  as  soon  as  it  was  born;  in  other  words,  the  idea  of 
a  committee  in  each  congressional  district  to  co-operate 
and  to  solicit  funds,  thus  distributing  the  burden  and  the 
interest  widely,  was  quickly  destined  to  failure.  As  an 
alternative  we  adopted  the  opposite  plan,  and  endeavored 
to  find  one  or  a  few  persons  who  would  assume  this  obli- 
gation. We  made  a  personal  visit  to  McDowell's  grand- 
daughter, Mrs.  William  M.  Irvine,  in  Richmond,  Kentucky. 
After  hearing  a  careful  presentation  of  what  had  already 
occurred,  Mrs.  Irvine  with  an  evident  degree  of  eagerness 
expressed  a  willingness  to  contribute  thirty-five  hundred 
dollars  for  the  purchase  of  the  house,  and  if  necessary  to 

266 


REVIEW  OF  THE  CORRESPONDENCE 

increase  this  to  four  thousand;  she  thought  that  thirty-five 
hundred  should  be  sufficient,  an  opinion  in  which  we 
fully  concurred. 

About  this  time  it  was  rumored  that  our  benefactress 
would  change  her  mind,  as  people  sometimes  do  in  making 
pledges.  In  this  case  we  cpnsider  these  rumors  to  have 
been  an  injustice  to  Mrs.  Irvine.  We  say  this  advisedly, 
not  only  because  she  was  so  evidently  interested  in  doing 
something  to  honor  her  illustrious  grandfather,  but  since 
her  children  had  passed  away  and  she  was  alone  and 
advanced  in  years,  her  affections  that  formerly  were 
divided  were  now  largely  centered  upon  her  grandfather, 
whose  memory  she  idolized  beyond  expression.  In  support 
of  this  view,  we  might  add  that  when  negotiations 
with  the  owner  of  the  property,  after  being  in  prog- 
ress for  some  months,  seemingly  began  to  lag,  with  a 
touch  of  impatience,  or  perhaps  added  determination,  she 
endeavored  to  hasten  matters,  as  the  following  statement 
made  fully  five  months  after  she  pledged  the  money  attests : 

I  have  been  disappointed,  not  having  heard  further  from 
you  concerning  the  McDowell  house  at  Danville.  I  am  a  little 
anxious  as  I  have  kept  idle  in  bank  between  four  and  five  thou- 
sand dollars  to  pay  for  it,  all  the  while  since  my  interview  with 
you  some  weeks  since. 

(Letter  of  April  ii,  19 13.) 

From  this  it  is  plain  that  this  pledge  was  not  to  be 
likened  to  those  spontaneous  expressions  that  are  made 
by  individuals  of  a  certain  type  one  day,  and  taken  back 
the  next.  Not  alone  does  the  continued  and  consistent 
interest  support  the  above  view,  but  there  were  reasons 
why  she  quickly  aligned  herself  with  the  movement  and 
eagerly  watched  its  development.  The  McDowell  house 
was  the  object  of  her  tenderest  affection,  partly  be- 
cause it  was  the  home  of  her  distinguished  grandfather 

267 


EPHRAiM  McDowell 

and  the  spot  where  the  first  ovariotomy  was  perform- 
ed and  also  because  it  was  her  birthplace,  as  well  as 
the  birthplace  of  her  elder  sister,  and  her  brother, 
Isaac  Shelby  Irvine.  It  was  a  family  custom  for  her 
mother  to  return  to  her  father's  house  for  her  con- 
finement, and  this  custom  was  carried  out  in  all  but  the  last 
confinement,  the  only  reason  for  this  exception  was  that 
Doctor  McDowell  had  but  a  short  time  before  passed  away. 

Furthermore,  when  a  schoolgirl  in  Danville,  she 
boarded  at  this  house,  which  according  to  Mrs.  Irvine 
was  then  the  residence  of  Mrs.  Lettie  Rochester,  and  her 
son-in-law.  Doctor  Beattie,  who  at  that  time  was  the 
president  of  Centre  College.  Her  letters  abounded  in  such 
expressions  as:  "I  prefer  to  buy  the  place  alone;  I  would 
wish  the  donation  for  myself."  .  .  . 

"I  feel  it  to  be  my  duty  and  ambition  as  the  only 
child  left  of  Ephraim  McDowell  to  present  this  property 
to  Danville."  ...  "I  neglected  to  tell  you  the  added 
interest  in  the  dear  old  place,  I  was  born  there."  .  .  . 
(Letter  of  February  8,  191 3.)  .  .  .  "That  little  side  plot 
was  my  grandmother's  flower  garden,  and  I  saw  traces  of 
it,  her  pretty  beds  when  I  was  a  schoolgirl  in  Danville," 
etc.  .  .  .  "If  I  should  be  so  fortunate  as  to  secure  the 
old  place."  .  .  .  (Letter  of  February  9,  1913.) 

We  do  not  feel  that  we  have  violated  the  confidence  of 
Mrs.  Irvine  in  using  these  extracts  from  her  letters,  since 
she  freely  used  these  and  other  expressions  in  her  conver- 
sations, and  they  only  reflect  that  which  was  uppermost 
in  her  mind  and  nearest  to  her  heart.  It  is  only  through 
their  publication  thatwe  can  adequately  defend  Mrs.  Irvine 
from  the  criticism  which  we  occasionally  heard,  that  it  was 
a  capricious  promise  without  any  substantial  foundation. 

Those  who  are  advanced  in  years,  especially  when  they 
have  reached  well  into  the  eighth  decade  of  hfe,  are  alone, 

268 


REVIEW  OF  THE  CORRESPONDENCE 

without  children,  and  reputed  to  be  wealthy,  are  nearly 
always  beseiged  by  all  kinds  of  people  with  all  kinds  of 
schemes,  and  to  this  rule  Mrs.  Irvine  was  no  exception. 
With  most  of  these  people  and  their  schemes,  she  seemed 
to  have  very  little  patience,  and  frequently  referred  to 
them  in  a  critical  vein,  but  when  it  came  to  the  idea  of 
buying  and  memorializing  this  house,  we  are  sure  that  this 
project  was  an  exception,  and  one  with  which  from  the  be- 
ginning slie  was  in  entire  accord.  Her  eagerness  and 
sincerity  were  so  evident  in  her  letters  and  conversa- 
tions, and  continued  to  remain  so  throughout  negotiations 
covering  a  period  of  more  than  a  year,  that  no  other 
conclusion  is  possible. 

When  the  negotiations  with  the  owner  of  the  house 
came  to  an  end,  owing,  as  we  feared  from  the  beginning, 
to  our  inability  to  reach  anything  like  a  reasonable  agree- 
ment as  to  price,  we  felt  that  the  spirit  of  her  offer  which 
had  remained  unchanged  for  more  than  a  year,  might  in 
the  end  be  made  to  bring  results  if  we  could  persuade  her 
to  place  with  some  Trust  Company  five  thousand  dollars 
as  a  nucleus  for  a  fund  to  build  a  suitable  monument 
later  to  her  grandfather,  either  in  Washington,  D.  C,  on 
account  of  its  international  character,  or  in  New  York 
City,  because  of  its  proximity  to  the  Old  World  and  its 
cosmopolitan  nature.  This  amount  was  to  be  a  nucleus, 
and  an  incentive  for  other  contributions  on  this  as  well 
as  the  other  side  of  the  Atlantic,  until  it  had  grown  to  a 
sum  adequate  for  the  purpose. 

This  idea  was  sympathetically  embraced,  as  the  fol- 
lowing extract  from  her  letter  of  Nov.  15,  191 3,  indicates: 

The  cause  is  all  you  claim  for  it  and  much  more.  My  heart 
is  in  it,  if  carried  out  In  such  a  way  as  to  be  worthy  of  the  grand 
object  we  have  in  view,  and  will  reflect  the  credit  and  renown  of 
Dr.  Ephraim  McDowell,   so  well  deserved,   so  long    delayed. 

269 


EPHRAiM  McDowell 

But  it  was  not  the  house;  it  was  different,  it  was  not 
so  simple,  it  was  compHcated,  it  required  co-operation 
that  carried  with  it  dread  of  disagreements,  and  respon- 
sibilities over  details;  it  was  remote  in  execution,  location 
and  nature.  Most  of  all  it  lacked  those  tender  associations 
with  the  house  itself,  that  meant  so  much  to  her.  Not- 
withstanding all  this  she  made  an  effort  worthy  of  applause, 
but  it  was  attended  with  such  stipulations,  all  made  with 
the  best  of  intentions,  that  unfortunately  so  complicated 
the  movement  as  to  place  its  consummation  beyond  the 
pale  of  a  possibility. 

Our  answer  to  these  impossible  stipulations  was  a 
frank  and  earnest  expression  of  opinion,  the  same  attitude 
that  attracted  her  when  we  presented  to  her  our  views  of 
the  house,  but  which  now  instead  of  attracting  her  had 
only  the  opposite  effect.  In  short  it  was  a  different 
story;  it  was  in  fact  an  entirely  different  task,  too 
complicated  to  be  grasped,  too  uncertain  to  be  tried, 
and  with  impossible  limitations.  We  realized  that  we 
had  reached  the  end.  The  termination  of  these  ef- 
forts impressed  us  as  one  of  the  most  melancholy  failures 
we  had  ever  encountered.  Here  were  two  figures,  the  one 
long  since  departed  and  the  other  still  living.  The  first 
was  one  of  the  foremost  benefactors  of  the  human 
race,  the  indirect  founder  of  the  most  brilliant  and  fruit- 
ful division  of  surgery,  a  hero  of  medicine  comparable  only 
to  the  discoveries  of  vaccination,  anaesthesia  and  aseptic 
surgery,  practically  unhonored  save  for  the  few  efforts 
which  were  entirely  out  of  proportion  with  the  importance 
of  his  achievements.  The  second  was  his  granddaughter, 
a  woman  fully  conscious  of  the  magnitude  of  her  grand- 
father's work,  and  equally  conscious  of  the  scant  recog- 
nition and  the  well-deserved  honors  long  since  overdue, 
in  the  autumn  of  her  life,  eager,  anxious,  and  able  to  do 

270 


REVIEW  OF  THE  CORRESPONDENCE 

something  toward  overcoming  this  neglect,  but  prevented 
and  defeated  through  her  own  inabihty  to  reach  the  con- 
clusion that  whatever  is  done  is  almost  of  necessity  pos- 
sible only  through  a  liberal  co-operation  with  others. 
What,  therefore,  might  not  only  have  been  accomplished, 
but  might  have  been  carried  out  during  the  lifetime  of 
the  donor,  under  her  own  supervision,  and  to  her  un- 
bounded satisfaction  in  seeing  her  fondest  wish  fulfilled, 
was  defeated  by  stipulations  and  conditions  that  were 
already  impossible,  and  that  were  destined  to  increase 
correspondingly  as  the  work  progressed. 

This  brings  us  to  the  second  division  of  our  task,  that 
of  reaching  a  reasonable  agreement  with  the  owner  of  the 
house.  This  involved  a  new  brand  of  trouble,  which 
although  simultaneous  in  its  development  with  the  other, 
differed  therefrom  in  being  devoid  of  any  encouragement 
whatever  from  the  outset,  instead  of  beginning  with  a 
bright  ray  of  hope  and  ending  in  despair,  as  was  the  case 
of  the  former. 

The  owner  of  the  house  is  Mr.  John  Gill  Weisiger,  of 
Danville,  Ky.  The  methods  we  pursued,  prior  to  bringing 
the  movement  before  the  public  through  the  Federation  of 
Women's  Clubs,  have  already  been  briefly  but  sufficiently 
explained.  Such  a  plan  of  procedure  for  obvious  reasons 
had  now  reached  its  limit,  so  we  began  negotiations  openly 
and  directly  with  the  owner. 

The  negotiations  commenced  with  the  following  letter : 

Mr.  John  Gill  Weisiger,  J""^  ^'  ^9I2. 

Danville,  Ky. 
Dear  Sir: 

On  last  Wednesday  I  made  an  appeal  to  the  Federation  of 
Women's  Clubs  to  purchase,  if  possible  at  a  fair  valuation,  the 
old  house  of  Doctor  McDowell  and  memorialize  it.  It  will 
require  much  effort  on  the  part  of  the  women  of   Kentucky  to 

271 


EPHRAiM  McDowell 

raise  funds  for  this  purpose.  Doctor  McDowell  has  done  so 
much  good  for  the  human  race  that  the  Federated  Clubs  feel 
that  his  memory  should  be  honored. 

It  seems  to  me  but  natural  that  his  memory  should  not  be 
neglected,  and  I  therefore  write  to  ask  you  to  kindly  state  your 
feelings  upon  the  subject  and  at  what  price  you  would  be  willing 
to  sell  the  house  in  order  that  it  can  be  memorialized. 

Hoping  to  be  favored  with  an  early  reply,  I  remain, 
Respectfully, 

(Signed)     August  Schachner. 

After  waiting  until  July  17th,  a  period  of  fully  six 
weeks,  for  an  answer,  we  mailed  the  second  letter: 

July  17,  1912. 
Mr.  John  Gill  Weisiger, 

Danville  Ky. 
Dear  Sir: 

On  June  ist,  I  wrote  you  a  letter  asking  you  to  kindly  express 
your  feelings  regarding  the  sale  of  the  old  McDowell  house  on 
Second  near  Main,  but  I  have  not  received,   as  yet,  any  reply. 

Certainly  a  man  who  has  done  so  much  for  the  human  race 
should  not  go  unhonored,  and  I  am  sure  this  house  which  stands 
for  so  much  deserves  a  nobler  fate. 

I  do  not  want  to  believe  that  you  would  forego  this  oppor- 
tunity to  help  in  honoring  a  benefactor  of  the  human  race, 
especially  as  it  only  means  to  you  the  selling  of  the  house  at  a 
full  and  fair  price  in  order  that  it  can  be  preserved,  as  it  richly 
deserves  to  be. 

I  cannot  conceive  of  anyone's  objecting  to  sell,  so  long  as 
they  will  not  lose,  but  in  selling  will  honor  themselves  by  aiding 
in  honoring  such  a  worthy  man. 

Will  you  not  kindly  think  this  over?  It  does  not  mean  any 
loss  to  you;  it  means  honor  to  you,  honor  to  your  family,  your 
town,  your  state,  and,  lastly,  to  a  deceased  townsman,  who  has 
done  so  much  good  in  this  world.    I  enclose  a  stamped  envelope. 

Hoping  to  be  favored  with  an  early  answer,  I  remain, 
Respectfully  yours, 

(Signed)     August  Schachner. 
272 


REVIEW  OF  THE  CORRESPONDENCE 

If  our  files  are  correct,  and  we  believe  them  to  be  so,  this 
also  remained  unanswered.  During  the  interim  we  visited 
Danville,  together  with  our  photographer,  Mr.  Henry 
Hesse,  and  while  there  we  called  upon  Mr.  Weisiger,  who 
unfortunately  happened  at  the  time  to  be  in  Louisville. 
We  were  welcomed  by  a  member  of  the  Weisiger  family 
who  had  just  returned  from  the  East,  and  in  view  of  obser- 
vations thus  made,  this  member  sympathetically  entered 
into  a  conversation  which  quickly  turned  upon  his- 
toric landmarks.  This  was  in  the  latter  half  of  the 
summer;  in  September  we  were  favored  by  a  visit  from 
Mr.  Weisiger,  during  which  we  mutually  discussed  the 
project.  In  this  interview  we  emphasized  the  salient 
points  and  to  the  best  of  our  abihty  appealed  to  him 
in  behalf  of  the  movement,  but  without  bringing  forth  a 
definite  answer.  In  the  course  of  this  conversation  Mr. 
Weisiger  informed  us  that  a  physician  in  Chicago  was 
contemplating  the  purchase  of  the  house  in  order  to 
cut  it  up  into  souvenirs  which  were  to  be  sold  at  the 
Panama-Pacific  Exposition  in  San  Francisco.  This  bit 
of  information  brought  forth  the  suggestion  that  the 
public  might  view  such  a  step  in  the  light  of  such  a 
sacrilege;  that  the  enterprising  doctor  might  have  a  job 
lot  of  expensive  kindling  wood  on  his  hands,  instead  of  a 
stock  of  valuable  souvenirs. 

Before  Mr.  Weisiger's  departure  he  agreed  to  the  pro- 
mise of  a  definite  answer  in  two  or  three  weeks.  After 
waiting  until  October  for  the  answer  without  receiving  any 
word,  we  wrote  reminding  him  of  this  promise.  Feeling, 
in  view  of  this,  that  the  next  move  was  distinctly  a 
Weisiger  move,  we  determined  to  settle  down  and  await 
his  action  calmly. 

After  a  delay  of  almost  four  months  Mr.  Weisiger 
made  the  move  in  the  form  of  the  following  letter: 

i8  273 


EPHRAiM  McDowell 

Danville,  Kentucky, 

Jan.  6,  1913. 
Dr.  August  Schachner, 
Louisville,  Ky. 

Dear  Sir: 

I  have  been  unable  to  give  you  a  price  on  the  Doctor 
McDowell  house,  situated  on  2nd  St.,  Danville,  Ky.,  until  now, 
I  am  now  having  it  vacated  and  can  give  you  a  price  until  the 
15th  of  Jan.,  1913,  and  if  not  accepted,  by  that  time,  this  price 
will  be  null  and  void,  and  the  house  off  the  market.  I  think  it 
has  a  frontage  of  about  sixty-five  feet  (65). 

I  enclose  under  cover  our  Danville  paper,  in  which  you  can 
see  the  feeling  of  Mrs.  Thomas  Jefferson  Smith,  of  Frankfort, 
at  a  meeting  of  the  Alumnae  of  State  University,  at  Lexington, 
Kentucky.  I  will  probably  be  in  Louisville  the  latter  part  of 
this  week  or  the  first  of  next. 

This  price  is  ten  thousand  dollars  (^10,000). 

If  you  should  conclude  to  take  it,  I  guess  satisfactory  pay- 
ments can  be  made. 

Respectfully, 

(Signed)     John  G.  Weisiger. 

Mr.  Weisiger's  letter  received  the  following  reply: 

Jan.  10,  1913. 
Mr.  John  G.  Weisiger, 
Danville,  Ky. 

Dear  Sir: 

Your  letter  of  January  6th  reached  me  Jany.  9th.  In  answer 
I  wish  to  say  that  since  the  Federation  of  Women's  Clubs  have 
pledged  themselves,  at  my  suggestion,  to  memorialize,  if  possible 
the  McDowell  house,  it  is  but  fair  and  proper  that  I  promptly 
convey  the  contents  of  your  letter  to  Mrs.  Thomas  Jefferson 
Smith,  the  President  of  the  Federation. 

Your  letter  was  received  on  the  9th  and  my  letter  to  Mrs. 
Smith  is  mailed  on  the  loth,  so  they  have  four  and  a  fraction 
days  according  to  your  letter,  in  which  to  act.  It  is  more  than 
likely  that  this  will  be  entirely  too  short  a  time  in  which  to 
properly  dispose  of  such  a  matter.    Under  what  circumstances 

274 


REVIEW  OF  THE  CORRESPONDENCE 

or  for  what  consideration  would  you  grant  an  option  for  two  or 
three  months  on  the  property? 

Awaiting  with  pleasure  your  proposed  visit,  I  remain, 
Respectfully  yours, 

(Signed)     August  Schachner. 

As  promptly  as  possible  a  copy  of  Mr.  Weisiger's  letter 
and  our  reply  were  conveyed  to  the  President  of  the 
Federation  of  Women's  Clubs,  together  with  a  note  of 
disapproval  of  Mr.  Weisiger's  extortionate  price. 

Mr.  Weisiger  failed  to  call  "the  latter  part  of  the  week 
or  the  first  of  the  next,"  as  he  suggested  in  his  letter  of 
January  6,  191 3. 

He  called  about  two  months  later,  and  in  this  inter- 
view it  was  made  plain  to  him  that  nothing  like  his  ten 
thousand  dollar  offer  would  receive  the  slightest  consider- 
ation. We  believed  his  attitude  unreasonable  and  told 
him  that  unless  he  changed,  we  would  fully  and  finally 
wash  our  hands  of  the  entire  affair.  Desiring  once  more 
to  renew  the  counter-offer  we  had  made  him,  we  tele- 
phoned to  the  hotel  at  which  we  understood  he  was  stop- 
ping, but  learning  that  he  had  not  been  there,  we  renewed 
the  offer  in  the  following  letter: 

Louisville,  Ky., 
March  14,  1913. 
Mr.  John  Weisiger, 
Danville,  Ky. 
Dear  Sir: 

When  you  left  my  office  I  understood  you  to  say  you  were 
stopping  at  the  Louisville  Hotel,  and  would  be  there  until  the 
next  evening.  I  telephoned  in  the  morning  hoping  to  arrange 
another  interview  with  you  but  was  informed  that  you  were 
not  stopping  there. 

I  have  been  promised  thirty-five  hundred  to  four  thousand 
dollars  with  which  to  buy  the  McDowell  house.  Would  you  be 
willing  to  sell  for  either  of  the  above  figures?    Unless  I  hear 

275 


EPHRAiM  McDowell 

from  you  within  a  week  of  this  date,  I  will,  after  working  on 
the  project  about  a  year,  feel  disposed  to  abandon  the  thought 
of  memorializing  the  house,  and  should  any  other  arrangements 
be  made,  Danville  will  be  probably  left  altogether. 

I  hope  that  you  will  be  generous  enough  to  favor  the  move- 
ment for  reasons  stated  in  former  letters,  and  I  want  to  believe 
that  you  are  above  trading  on  the  sentiment  that  the  historic 
value  involves.  It  has  been  said  that,  if  this  house  is  permitted 
to  pass  into  oblivion,  posterity  will  point  the  finger  of  scorn  at 
Danville  for  not  interesting  itself  more  in  the  home  of  its  greatest 
citizen,  and  foremost  benefactor  of  the  human  race.  I  feel  with 
others  that  the  house,  as  a  house,  is  only  worth  about  twenty- 
five  hundred  dollars,  and  very  likely  it  was  bought  and  is 
assessed  for  even  less  than  that  figure. 

Awaiting  your  reply,  I  remain, 

Respectfully  yours, 

(Signed)     August  Schachner. 

This  letter  remained  unanswered,  but  in  June,  1913, 
we  received  the  appended  letter: 

Danville,  Ky., 
June  27,  1913. 
Dr.  August  Schachner, 

Louisville,  Ky. 
Dear  Sir: 

I  have  concluded  to  make  you  this  offer  if  you  wish  to  pre- 
serve the  McDowell  building.  My  price  is  $10,000  (ten  thou- 
sand dollars).  I  will  donate  twenty-five  hundred  of  that  amount 
myself  leaving  seventy-five  hundred.  I  think  the  frontage  is 
about  sixty  feet.  I  will  be  in  Louisville  sometime,  I  think,  this 
or  next  week,  and  if  you  care  to  take  up  the  matter  you  can 
advise  me  by  mail  and  I  will  let  you  know  the  exact  date  I 
will  be  there. 

Respectfully, 

(Signed)     John  G.  Weisiger. 

Since  we  had  made  our  views  so  plain  to  Mr.  Weisiger 
during  our  last  conversation,  and  reiterated  the  same  in 
our  letter  of  March  14,  1913,  we  did  not  feel  called  upon 

276 


REVIEW  OF  THE  CORRESPONDENCE 

to  pursue  the  matter  any  farther,  so  his  letter  of  June  27, 
1913,  remained  unanswered. 

In  the  latter  part  of  March  our  final  report  of  the  nego- 
tiations was  transmitted  to  the  President  of  the  Federa- 
tion of  Women's  Clubs  in  the  subjoined  communication. 

Louisville,  Ky.,  March  29,  1913. 
Mrs.  Thomas  Jefferson  Smith, 
Frankfort,  Ky. 

Madam  President: 

Your  note  of  Feb.  loth  received.  Its  delayed  answer  was 
occasioned  by  the  unavoidable  drag  in  the  attempted  negotia- 
tions. I  regret  that,  so  far  as  my  personal  efforts  in  the  move- 
ment are  concerned,  it  becomes  necessary  for  me  to  forego 
further  efforts,  so  I  am  making  this  my  last  report. 

Not  wishing  to  overstep  the  limits  of  time  and  space  too 
much,  I  mention  but  the  salient  points,  relying  upon  my  past 
correspondence  to  supply  such  detail  as  may  be  desired. 

The  idea  of  memorializing  this  important  landmark  was 
not  original  with  me,  but  I  hoped  that  where  others  remained 
inactive  that  I  might,  before  it  is  too  late,  with  the  co-operation 
of  the  Federated  Women's  Clubs  of  the  State,  succeed.  I  natur- 
ally looked  to  the  women  because  they  were  McDowell's  first 
beneficiaries. 

It  is  now  more  than  a  year  since  I  took  up  the  work,  and 
during  this  period  the  best  part  of  the  time  I  could  spare  from 
a  fairly  busy  life  was  dedicated  to  the  effort.  Aside  from  the 
time  and  labor  which  were  easily  the  greatest  toll,  the  expense 
account  reached  close  to  the  five  hundred  mark. 

During  this  time  a  kindly  sympathy  was  shown  me  by  Mr. 
John  A.  Quisenbury,  of  Danville,  for  which  I  feel  very  grateful. 
No  other  aid,  however,  bearing  upon  the  movement  to  memorial- 
ize the  house  by  the  Federation  was  I  believe  rendered  me. 

I  purposely  carried  on  the  work  single-handed  for  the  first 
six  months,  or  until  my  communication  with  you  of  November 
19,  1912.  Since  that  date,  I  have  been  hoping  to  see  some  real 
signs  of  activity  from  other  quarters.  In  view  of  the  pressure 
from  other  important  matters,  I  feel  unable  to  give  the  move- 
ment further  active  interest,  still  hoping,  however,  that  from 

277 


EPHRAiM  McDowell 

the  Kentucky  Federation  of  Women's  Clubs,  the  large  and  illus- 
trious number  of  descendants  of  this  public  benefactor,  and  the 
people  of  Danville,  if  not  the  State  of  Kentucky,  some  one  or 
all  will  arise  equal  to  the  emergency  of  honoring  the  greatest  of 
all  Kentuckians,  if  not  the  greatest  of  all  Americans. 

I  am  enclosing  the  last  letter  to  John  G.  Weisiger,  which 
as  yet  he  has  failed  to  answer.  The  paper  upon  McDowell  will 
appear  in  May  and  I  will  be  pleased  to  send  you  a  few  reprints. 

Thanking  you  very  kindly  for  your  personal  efforts  in  the 
matter,  and  heartily  wishing  the  movement  every  measure  of 
success,  I  remain. 

Respectfully  yours, 

(Signed)     August  Schachner. 

To  this  fairly  complete  review  there  is  but  little  more 
to  be  added.  It  has  been  conservatively  estimated  in 
Danville,  that,  aside  from  its  historic  value,  the  house 
w^as  v^orth  about  ^1500.00,  yet  the  maximum  of  ^4000.00 
was  offered  and  refused.  It  is  our  impression  that  at  the 
time  that  these  offers  were  made  it  yielded  a  gross  revenue 
of  ^22.00  per  month  In  rental.  If  the  maximum  amount 
offered  for  the  house  had  been  accepted  and  properly  in- 
vested, it  would  in  all  probability  have  yielded  a  better 
net  return  than  the  house  did  at  a  rental  of  ^22.00,  not 
to  mention  the  increase  in  the  capital  Involved,  as  repre- 
sented by  the  difference  between  $1500.00  and  $4000.00. 

In  the  absence  of  the  sentiment  Involved,  which  we 
believe  should  be  above  commercialization,  the  offer  was 
considered  by  those  competent  to  judge  a  very  Hberal  one. 

Explanations  alike  in  tone  were  freely  offered,  bearing 
upon  our  inability  to  reach  an  agreement,  and  with  these 
we  were  fully  in  accord,  but  we  doubt,  however,  if  these 
explanations  will  be  sufficient  to  spare  the  citizens  and 
the  civic  influences  of  Danville  from  the  criticisms  that 
in  all  likelihood  will  sooner  or  later  arise. 

There  was  a  time  when  the  McDowell  house  did  not 

278 


REVIEW  OF  THE  CORRESPONDENCE 

belong  to  Mr.  Weisiger,  and  if  we  bear  in  mind  that  Mr. 
Weisiger  is  also  the  owner  of  the  dignified  old  statehouse 
which  is  in  an  equally  grimy  condition,  it  is  evident  that 
Mr.  Weisiger  owns  about  everything  that  is  left  in  Danville 
of  a  historic  nature,  which  is  worth  owning.  In  view  of 
this,  it  is  difficult  to  escape  the  conclusion  that  Mr. 
Weisiger  is  perhaps  after  all  about  as  public-spirited  as 
the  average  citizen  of  Danville,  and  that  he  differs  from 
his  fellow  townsmen  mainly  in  being  more  keenly  alive 
to  the  relative  values,  especially  in  real  estate,  that  exist 
in  his  community. 

It  would  seem  that  in  a  community  so  teeming  with 
history,  and  fortunately  possessing  such  a  splendid  moral 
force  as  Centre  College,  that  this  institution  would  in 
itself  have  insured  the  preservation  of  the  rapidly  fading 
historical  atmosphere  in  which  this  place  abounds.  To 
have  essayed  successfully  such  a  role  would  have  been  at 
one  and  the  same  time  an  index  of  its  culture,  and  an 
asset  in  its  prosperity. 

Notwithstanding  the  neglect  and  degradation  to  which 
the  house  has  so  long  been  exposed,  it  is  still  a  dignified 
old  structure  that  would  attract  attention,  place  it  where 
you  will.  What  its  future  will  be  is  difficult  to  say;  pos- 
sibly some  night,  as  the  outcome  of  revelry,  it  will  take 
fire,  and  then  its  existence  will  be  a  mere  matter  of  history. 
So  far  as  its  preservation  is  concerned,  much  as  we 
should  hail  such  an  event,  it  seems  now  more  remote 
than  ever.  After  a  lapse  of  eight  years,  we  had  occasion  to 
motor  to  Danville,  and  during  this  visit  we  gave  the  house 
another  careful  study.  Since  our  last  visit,  the  house  had 
continued  its  downward  course  until  it  has  reached  a  point 
where  it  now  seems  almost  beyond  redemption.  The 
room  that  served  as  the  original  office  of  McDowell  is 

279 


EPHRAiM  McDowell 

now  used  as  a  shoe-shining  booth  for  negroes.  The  room 
in  the  rear  of  the  corresponding  front  room  on  the  second 
floor,  which  is  on  a  lower  level  by  several  feet,  is  used  as  a 
dump  for  the  ashes  from  the  grates  of  the  rooms  on  the 
second  floor.  So  far  as  the  occupants  are  concerned  no 
remarks  are  necessary. 

The  original  building,  although  of  wood  and  erected 
about  a  century  and  a  half  ago  or  possibly  more,  is  still 
in  a  somewhat  serviceable  state.  However  it  can  hardly 
be  expected  to  continue  in  this  badly  neglected  condition 
much  longer.  From  the  increasing  rapidity  of  its  down- 
ward course,  its  end  may  come  at  any  time.  Feeling  that 
a  diagram  of  the  house,  in  addition  to  the  photographs, 
would  be  of  interest  and  value  to  future  students,  we 
availed  ourselves  of  the  generous  services  of  Mr.  Frederick 
Erhart,  an  architect  of  Louisville,  who  kindly  drew  the 
accompanying  plans  of  the  structure. 

In  addition  to  these  drawings,  a  few  descriptive 
remarks  are  needed  in  order  to  preserve  this  accurately 
for  future  purposes.  The  original  structure  consists  of  a 
four-room  frame  dwelling — assuming  that  the  hall  room  on 
the  second  floor  was  an  afterthought — ^with  a  cellar  and  an 
attic.  The  brick  additions  are  of  a  later  period  and  may 
have  been  added  at  different  dates.  The  inspection  of  the 
cellar  and  the  attic  was  well  worth  the  trouble,  inasmuch 
as  they  revealed  the  peculiarities  of  construction  in  vogue 
during  the  earliest  period  in  the  settlement  of  our  state. 

The  former,  which  continued  the  length  of  the  build- 
ing, was  used  for  storage  purposes,  and  the  latter  could 
have  served  the  same  end,  but  under  stress  of  circum- 
stances might  have  been,  and  probably  was,  employed 
as  a  dormitory.  It  had  a  moderate-sized  window  at  each 
end,  was  without  partitions,  and  had  a  fairly  high  but 
sloping  top  that  remained  unsealed. 

280 


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PLAN  OF  THE  McDOWELL  HOUSE 

On  the  ground  floor  were  two  rooms  separated  by  a 
hall.  The  room  to  the  right,  at  one  time,  undoubtedly 
served  as  McDowell's  office,  and  the  one  on  the  left  is 
equally  certain  to  have  served  as  a  reception  parlor.  On 
the  second  floor  we  have  two  rooms  corresponding  to 
those  on  the  first  floor.  There  is  a  hall  room  on  the  second 
floor  which  corresponds  to  the  middle  front  window. 
Mr.  Erhart  considers  this  an  afterthought  and  not  part 
of  the  original  arrangement  of  the  building. 

Originally  there  was  but  one  front  entrance,  with  two 
windows  on  each  side;  later  on  one  of  these  windows  was 
converted  into  a  second  entrance.  The  windows  were 
large,  and  each  sash  contained  twelve  moderate-sized 
lights.  The  cellar  was  walled  in  with  masonry.  There 
was  a  rear  porch  that  later  on  was  converted  into  a  room. 
The  additions  are  of  brick  and  most  likely  represent  dif- 
ferent dates  in  their  construction.  The  larger  one  adjoin- 
ing the  right  half  of  the  building  was  probably  erected 
first.  The  first  floor  of  this  addition  consists  of  two  rooms 
separated  by  an  open  hallway.  This  hallway  served  as  a 
vestibule  to  a  staircase  leading  to  the  second  floor  and 
contained  a  door  leading  into  the  room  just  behind  the 
office.  This  room  probably  served  as  a  dining  room.  The 
rear  room  in  this  addition  undoubtedly  was  the  kitchen. 
The  second  floor  consists  of  a  room  and  a  loft,  or  store 
room,  separated  by  a  hall  and  stairway.  The  loft  was  over 
the  kitchen,  and  the  room  adjoining  the  front  room  of  the 
frame  building  was  the  one  referred  to  as  an  ash  dump. 

The  small  brick  addition,  located  to  the  left  of  the 
building  and  probably  of  later  construction,  is  unequally 
divided  into  two  small  rooms  connected  through  a  door- 
way. The  front  or  the  larger  of  the  two  is  connected 
with  the  reception  parlor,  and  the  rear  room  is  connected 
with  the  covered  porch. 

281 


EPHRAiM  McDowell 

This  brick  addition  has  been  regarded  by  many  as 
his  operating  room,  and  the  particular  spot  where  the  first 
ovariotomy  was  performed. 

In  the  drawings  the  doors  are  shown  as  open  spaces, 
and  the  windows  by  the  horizontal  shading.  These  draw- 
ings do  not  include  his  later  office,  which  was  a  separate 
one-story  brick  building  to  the  right  of  the  original  frame 
structure,  and  is  now  being  used  as  a  negro  pool  room. 
There  was  no  cellar  under  any  of  the  brick  additions. 

At  present  this  shrine  serves  the  inglorious  purpose  of 
affording  a  small  rental  to  the  owner  on  the  one   hand, 
and  a  few  miserable  souvenirs  to  the  curious  public  on 
the  other  hand.    Occasionally  a  more  Hberal  fragment  of 
its  woodwork  is  removed  for  the  purpose  of  making  a 
gavel  for  the  use  of  some  medical  society.     There  is  a 
certain  type  of  individual,  who  feels  and  acts  as  though 
this  house  and  its  historic  analogue,  the  first  capitol  of 
the  state,  were  built  expressly  to  supply  wood  for  the 
making  of  gavels  to  be  used,  in  the  one  case  for  conducting 
medical  meetings,  and  in  the  other,  to  serve  a  similar  role 
in  legal  societies.  It  was  rumored  that  one  of  the  mantels 
was  removed  to  a  private  institution  in  the  town,  and 
that  the  doorway  has  more  than  once  been  considered  in 
connection  with  some  of  the  attractive  homes  of  Danville. 
Although  such  foibles  in  human  nature  are  hardly  to 
be  commended,  we  will  defend  the  removalof  the  door- 
knocker, and  its  presentation  to  Dr.  Samuel  D.  Gross. 
In  the  first  place,  since  the  neighborhood  has  deteriorated 
to  such  a  degree,  it  might  have  been  removed  without 
permission,  and  for  no  other  reason  than  the  commercial 
value  of  the  metal  or  the  novelty  it  possessed.    Secondly, 
if  any  single  person  was  entitled  to  it,  it  was  Samuel  D, 
Gross,  who  did  more  to  defend  the  claims  of  McDowell 
and  to  honor  his  memory  than  any  other  individual. 

282 


PLAN  OF  THE  McDOWELL  HOUSE 

In  bringing  this  study  of  Ephraim  McDowell  toward  a 
close,  and  before  passing  to  the  heroine  in  this  drama  that 
was  fraught  with  such  benefits  to  humanity,  and  that  is 
so  inseparably  blended  with  the  art  of  surgery,  we  are 
unable  to  refrain  from  expressing  the  hope  that  the 
foregoing  lines  will  act  as  a  stimulus  to  others  to  continue 
this  study;  and  to  accomplish  some  of  the  endeavors 
that  have  been  attempted  in  the  past,  but  failed. 

If  the  present  work  should  in  any  way  aid,  or  lighten 
the  burden  of  others,  who  we  hope  will  follow  in  the  foot- 
steps of  those  that  have  in  the  past  dedicated  themselves 
to  this  task,  it  will  add  greatly  to  the  pleasure  which  this 
undertaking  has  afforded  us. 


283 


CHAPTER  XIV 

JANE  TODD  CRAWFORD,  THE  HEROINE  OF  THE  FIRST  OVARIOTOMY 

One  of  the  most  notable  features  in  connection  with 
the  first  ovariotomy  is  the  completeness  with  which  the 
heroine  has  disappeared  from  view,  although  it  is  true 
that  McDowell  himself  has  faded  out  until  but  little  more 
than  the  mere  outlines  of  his  life  remain. 

There  is  usually  a  lapse  of  time  following  the  death  of 
one,  more  or  less  entitled  to  fame,  before  the  history  of 
his  life  is  reduced  to  writing.  His  contemporaries  are  so 
close  to  him  and  feel  so  familiar  with  all  details  that  it  is 
not  considered  necessary  to  set  them  down.  Moreover, 
unless  it  is  delayed  too  long,  biography  is  frequently  best 
accomplished  through  the  next  generation  who  can  write 
from  a  clearer  point  of  view.  A  biography  is  after  all 
but  the  history  of  an  individual  life,  and  since  history 
is  never  revealed  in  its  entirety  at  any  particular  period 
or  to  any  particular  person,  it  is  obvious  that  it  takes 
both  time  and  persons  to  secure  a  well-rounded  history 
on  the  one  hand,  and,  what  is  of  equal  importance,  the 
correct  relationship  between  individuals  and  the  events 
that  preceded  and  succeeded  the  history  involved,  on  the 
other  hand. 

His  contemporaries,  and  the  generation  that  followed 
McDowell,  who  gave  us  those  first  few  sketches  of  his  life, 
could  not  fully  realize  at  that  time  the  intricate  and 
marvelous  development  of  abdominal  surgery,  which  was 
the  logical  outcome  of  the  discovery  that  the  peritoneal 
cavity  could  under  proper  precautions  be  surgically  invaded. 

This  discovery,  which  was  so  promptly  recognized  by 
the  English,  was  almost  entirely  overlooked  by  his  own 

284 


JANE  TODD  CRAWFORD 

countrymen;  at  least  a  very  careful  survey  of  our  litera- 
ture supports  such  a  belief.  Hence,  most  of  the  early 
sketches,  judged  from  this  viewpoint  were  not  only  made 
prematurely,  but  seemingly  were  largely  based  upon 
information  transmitted  from  his  generation  to  the  next, 
and  apparently  accepted  without  any  reservation,  or 
special  effort  at  verification.  This  to  a  considerable  ex- 
tent explains  the  origin  of  the  conflicting  dates,  state- 
ments, and  omissions,  which  were  accepted  as  final  and 
transmitted  from  one  writer  to  the  next  in  the  form  in 
which  they  were  received. 

If  this  applies  to  McDowell,  it  is  but  reasonable  that 
the  same  obscurity  should  apply  in  even  a  far  greater 
degree  to  Jane  Todd  Crawford,  whose  role,  however 
important,  was  after  all,  if  not  secondary,  at  least,  the 
passive  one  in  comparison  with  that  of  McDowell's. 
Here  we  have  an  explanation  of  how  Jane  Todd  Craw- 
ford, in  all  but  name,  gradually  disappeared  until  she  was 
referred  to  from  one  writer  or  speaker  to  the  next  merely 
as  Mrs.  Crawford,  of  Green  County.  In  short,  she  was 
as  completely  ignored  as  circumstances  permitted;  she 
was  only  mentioned  whenever  it  became  necessary  to 
do  so  in  order  to  discuss  the  first  ovariotomy  intelli- 
gently, and  after  that  all  interest  ceased.  While  this 
omission  of  all  but  name  was  an  injustice  to  the  heroine, 
and  while  this  neglect  involved  McDowell  as  well  as  Jane 
Todd  Crawford,  we  had  hoped  that  after  attention  had 
been  called  thereto,  it  would  cease,  and  that  she  would  at 
least  receive  her  proper  place  in  history,  if  not  some  sem- 
blance of  the  recognition  to  which  she  was  justly  entitled. 

In  the  paper  upon  McDowell,  which  was  read  before 
the  Johns  Hopkins  Historical  Club,  and  published  in  the 
Johns  Hopkins  Hospital  Bulletin  of  May,  191 3,  we 
included  a  brief  sketch  of  the  heroine,  relying  upon  a 

285 


EPHRAiM  McDowell 

future  occasion,  when  more  time  and  space  were  avail- 
able, to  present  the  results  of  our  investigation  upon  this 
subject  adequately.  In  the  above  paper  this  neglect, 
as  well  as  the  condition  into  which  the  McDowell  house 
had  fallen,  was  plainly  brought  out.  We  had  hoped  that 
since  this  duty  of  calling  attention  to  these  defects,  al- 
though not  exactly  a  pleasant  one,  had  been  fulfilled 
without  evasion,  future  writers  would  be  influenced 
thereby,  and  would  co-operate  in  presenting  the  story 
as  it  exists  with  all  of  its  features,  favorable  and  unfa- 
vorable, included.  This  would  represent  a  true  history,  in 
contrast  to  the  presentations  of  the  subject  so  typical  of 
the  past,  which  has  usually  included  only  such  features  as 
appealed  to  the  writer. 

When  we  began  receiving  communications  such  as 
the  appended  letter,  and  in  our  answer  had  emphasized 
the  shocking  condition  into  which  this  shrine  had  fallen, 
our  hope   in  an  awakened  consciousness  was    renewed. 

Kentucky  State  Medical  Association 

Bowling  Green,  Ky.,  May  i6,  1916. 

Dr.  August  Schachner, 
Louisville,  Kentucky. 

Dear  Dr.  Schachner: 

You  will  be  interested  to  know  that  there  has  recently  come 
into  my  possession  an  original  letter  of  several  pages,  written 
in  1829,  from  Ephraim  McDowell  to  a  medical  student  then  in 
Philadelphia,  giving  a  full  account  of  the  circumstances  under 
which  his  first  ovariotomy  was  performed  and  the  facts  in  regard 
to  ten  other  cases.  Before  framing  this  letter  for  permanent 
preservation  in  the  Historical  Society  or  elsewhere,  I  am  having 
a  facsimile  of  it  made  for  publication  in  an  early  issue  of  the 
State  Journal,  together  with  Doctor  McDowell's  picture,  q. 
picture  of  his  home,  and  such  other  data  as  may  be  available 
and  pertinent. 

286 


JANE  TODD  CRAWFORD 

Knowing  that  you  prepared  a  paper  on  this  subject  for  the 
Johns  Hopkins  people,  I  am  writing  to  ask  if  you  could  be  kind 
enough  to  send  this  to  me  and  to  put  me  in  the  way  of  finding 
such  cuts  or  other  kindred  matter  as  would  be  of  interest  to 
the  profession. 

Thanking  you  in  advance  for  any  assistance  and  advice 
you  can  give  me  in  regard  to  this  matter,  I  am, 
Yours  sincerely, 

(Signed)     J.  N.  McCormack. 

Dr.  J.  N.  McCormack,  ^^^  ^7,  1916. 

Bowling  Green,  Ky. 

Dear  Doctor  McCormack: 

Your  letter  of  the  i6th  received,  and  in  answer  will  say  that 
it  is  a  pleasure  to  send  you  a  copy  of  the  McDowell  address 
before  the  Johns  Hopkins  Historical  Society.  You  will  find  in 
this  a  fairly  concentrated  statement  of  the  case. 

Every  effort  to  do  justice  to  a  benefactor  of  the  human  race 
should  be  encouraged,  especially  when  he  is  a  member  of  the 
Medical  profession,  since  the  importance  of  our  work  is  so 
commonly  ignored. 

I  am  sending  the  photo  of  his  Danville  residence  in  which 
the  operation  was  performed,  showing  the  submerged  condition 
to  which  this  shrine,  that  so  richly  deserves  the  reverence  of 
the  human  race,  has  fallen. 

I  would  very  much  appreciate  a  copy  of  the  Journal  contain- 
ing your  article  on  McDowell,  as  well  as  any  information  on  the 
subject  you  may  convey. 

Wishing  you  much  success,  I  remain, 
Sincerely  yours, 

(Signed)     August  Schachner. 

Unfortunately,  however,  the  story  of  this  nero  as 
recorded  in  the  Historical  Number  of  the  Kentucky  Medi- 
cal Journal,  is  hardly  more  than  a  recognition  of  one  of 
the  greatest  of  all  surgeons,  and  as  for  any  interest  in  the 
submerged  shrine  emphasized  in  our  letter,  or  any  justice 

287 


EPHRAiM  McDowell 

to  Jane  Todd  Crawford  mentioned  in  the  paper  read  before 
the  Johns  Hopkins  Historical  Society,  we  regret  to  say 
that  our  suggestions  were  not  followed.  It  is  strange 
that  there  should  remain  any  indifference  upon  these  two 
features  after  attention  has  been  directed  thereto,  and 
equally  strange  that  explanations  should  be  necessary 
in  order  to  estabhsh  Jane  Todd  Crawford's  claims  to 
something  like  an  adequate  recognition. 

History  affords  isolated  instances  in  which  women  sub- 
mitted to  heroic  surgical  measures  under  somewhat  similar 
conditions  to  that  of  the  first  ovariotomy,  notably  in 
Caesarean  section,  ectopic  gestation, intestinal  obstruction, 
and  other  abdominal  conditions,  but  in  none  of  these  did 
the  benefits  extend  beyond  the  immediate  person  con- 
cerned. They  were  not  attended  with  any  beneficent  influ- 
ence that  expanded  through  time,  certainly  not  such  as 
in  the  case  of  Mrs.  Crawford,  that  led  not  alone  to  the 
emancipation  of  her  sex  from  one  of  the  most  distressful 
and  fatal  conditions  to  which  they  might  be  exposed,  but 
to  the  eternal  advantage  of  all  ages,  sexes,  and  races  for 
all  time  to  come  and  to  a  degree  that  surpassed  the 
wildest  dreams.  The  mere  fact  that  she  was  the  prin- 
cipal beneficiary  in  the  first  ovariotomy  hardly  absolves 
the  succeeding  generations  from  ignoring  the  debt  of  gra- 
titude they  owe  to  her.  It  was  through  her  heroism  that 
primarily  ovariotomy,  and  secondarily  abdominal  surgery 
with  all  of  its  ramifications  became  possible.  Since  this 
contributed  to  the  lasting  benefits  of  the  public  in  general, 
and  the  profession  in  particular,  itwould  be  nothing  short  of 
ingratitude  to  ignore  the  claims  of  Mrs.  Crawford  as  being 
in  keeping  with  those  of  the  hero,  especially  if  we  remember 
that  the  idea  of  ovariotomy  did  not  originate  with  McDowell. 
This  deed,  which  liberated  not  alone  her  sex,  but  the 

288 


JANE  TODD  CRAWFORD 

whole  of  mankind  from  an  amount  of  invalidism  and 
premature  death  beyond  all  human  calculation,  was  made 
possible  by  Jane  Todd  Crawford's  successfully  balancing 
her  heroism  against  Ephraim  McDowell's  genius.  On 
this  priceless  gift  is  based  the  enduring  obligation 
that  humanity  owes  to  Ephraim  McDowell  and  Jane 
Todd  Crawford. 

In  his  first  public  communication  McDowell  himself 
unconsciously  recognized  Mrs.  Crawford's  share  in  the 
glory  when  he  spoke  of  her  as  "willing  to  undergo  the 
experiment,"  which  remark  she  made  after  he  had  frankly 
explained  to  her  the  gloomy  outlook.  If  there  was 
nothing  more  than  her  heroism,  her  entire  willingness, 
and  her  insistence  on  trying  the  experiment,  this 
together  with  the  difficulties  and  dangers  that  attended 
her  from  the  time  that  she  left  her  home  until  she 
returned,  these  were  quite  enough  to  inspire  McDowell 
and  to  entitle  her  to  a  share  of  the  glory.  The  encour- 
agement that  Mrs.  Crawford  could  not  help  giving 
to  McDowell  through  her  outspoken  willingness  to 
attempt  the  "experiment,"  notwithstanding  his  discour- 
aging explanation,  adds  greatly  to  the  importance  of 
the  role  she  assumed  upon  that  memorable  occasion. 

Nor  is  this  the  first  public  recognition  of  her  claims. 
Dr.  Lewis  A.  Sayre,  as  President  of  the  American  Medical 
Association,  referred  to  these  in  his  address  delivered 
during  the  memorial  exercises  held  in  Danville  in  1879. 

Doctor  Sayre,  after  the  following  tribute  to  the  hero: 

I  venture  here  the  prediction  that  in  all  time  to  come  the 
intelligent  surgeons,  either  in  person  or  in  thought,  from  every 
part  of  the  civilized  globe,  will  wander  here  to  Danville  to  pay 
their  respects  and  sense  of  obligation  to  the  memory  of  Ephraim 
McDowell,  who  has  contributed  more  to  the  alleviation  of 
human  suffering  and  the  prolongation  of  human  life  than  any 
other  member  of  the  medical  profession  in  the  nineteenth  century 

19  289 


EPHRAiM  McDowell 

— refers  to  the  heroine  by  saying: 

Another  fact  strikes  me  very  forcibly,  Mr.  President,  and 
that  is,  the  heroic  character  of  the  woman  who  permitted  this 
experimental  operation  to  be  performed  upon  her.  The  women 
of  Kentucky  in  that  period  of  her  early  history  were  heroic  and 
courageous,  accustomed  to  brave  the  dangers  of  the  tomahawk 
and  scalping-knife,  and  had  more  self-reliance  and  true  heroism 
than  is  generally  found  in  the  more  refined  society  of  city  life; 
and  hence  the  courage.  Mrs.  Crawford,  who,  conscious  that 
death  was  inevitable  from  the  disease  with  which  she  suffered, 
so  soon  as  this  village  doctor  explained  to  her  his  plan  of  afford- 
ing her  relief,  and  convinced  her  judgment  that  it  was  feasible, 
immediately  replied,  ^^ Doctor,  I  am  ready  for  the  operation; 
please  proceed  at  once  and  perform  it."  (Italics  my  own.)  All 
honor  to  Mrs.  Crawford!  Let  her  name  and  that  of  Ephraim 
McDowell  pass  down  in  history  together  as  the  founders  of 
ovariotomy! 

When  it  came  to  unraveling  the  history  of  Mrs.  Craw- 
ford, it  is  impossible  to  describe  adequately  the  apparent 
hopelessness  of  the  task  with  which  we  were  confronted. 
Where  confusion  and  contradiction  existed  in  the  story  of 
McDowell,  a  state  of  complete  vacuity  presented  itself 
in  regard  to  Mrs.  Crawford.  Writing  to  Green  County, 
Ky.,  whence  she  came,  was  like  trying  to  correspond  with 
someone  in  another  planet,  and  going  further  back  to 
Virginia,  the  earliest  home  of  the  Crawfords,  only  added 
to  our  discouragement. 

In  a  private  correspondence  with  Mr.  Jos.  A.  Waddell, 
of  Staunton,  Virginia,  we  were  informed  that  the  Craw- 
fords are  numerous  in  Augusta  County,  and  have  been  so 
from  the  earliest  settlement.  In  ferreting  about,  traces 
were  discovered  indicating  that  the  Crawfords  moved  to 
the  neighboring  state  of  Indiana.  Beginning  with  a 
residence  opposite  Madison,  on  the  Ohio  River,  then 
Madison,   Bloomington,    a   settlement   on   the  Wabash 

290 


JANE  TODD  CRAWFORD 

River,  and  Logansport,  all  of  which  served  as  places 
of  residence  after  the  Crawfords  left  Green  county, 
nothing  definite  except  the  merest  indirect  allusions  sup- 
porting the  foregoing  residing  places  could  be  obtained. 

It  was  in  our  inquiry  upon  McDowell,  which  involved 
an  extensive  correspondence,  that  the  name  of  Miss  Amelia 
M.  Crawford  occurred.  The  address  of  Miss  Crawford 
was  promptly  obtained  and  a  correspondence  entered  into. 
We  found  that  she  resided  in  Covington,  Ky.,  and  was 
the  granddaughter  of  the  heroine.  She  favorably  remem- 
bered Dr.  Samuel  D.  Gross,  the  benefits  of  whose  surgical 
skill  she  had  received. 

After  an  extended  correspondence  we  had  the  pleasure 
of  occasionally  having  Miss  Crawford  as  our  guest  during 
her  annual  visits  to  her  friends  and  relatives  in  Louisville. 
Although  well  in  the  eighth  decade  of  life,  she  was  wonder- 
fully active,  and  possessed  mental  faculties  absolutely 
unimpaired.  In  point  of  courage,  optimism,  and  the 
soundness  of  her  philosophy  of  life,  she  was  altogether  an 
exceptional  personality.  After  meeting  Miss  Crawford 
you  would  be  able  to  appreciate,  in  a  degree,  the  aid  which 
her  well-balanced  and  courageous  grandmother  must 
have  rendered  McDowell  when  he  undertook  the  all- 
important  "experiment."  Miss  Crawford  co-operated 
patiently  and  earnestly  in  developing  the  history  of  her 
grandmother.  Her  most  important  step  was  bringing 
about  an  exchange  of  letters  between  her  cousin  Mr.  J. 
Knox  Mitchell,  alawyerofOsborne,  Kansas,  and  the  author. 

Mr.  Mitchell,  who  is  a  grandnephew  by  marriage  of 
the  heroine,  deserves  the  greatest  praise  for  the  patience 
and  persistence  with  which  he  continued  the  task.  With- 
out his  assistance  the  success  of  our  endeavors  would 
have  been  extremely  doubtful;  and  the  credit  for  finally 
discovering  the  grave  of  Mrs.  Crawford,  which  will  be 

291 


EPHRAiM  McDowell 

referred  to  more  in  detail  farther  on,  is  in  our  judgment 
due  more  to  the  efforts  of  J.  Knox  Mitchell  than  anyone  else. 

In  recording  the  meagre  results  of  our  inquiry  into  the 
genealogy  of  Jane  Todd  Crawford,  we  have  advisedly 
included  many  details  in  order  that  our  method  of  reaching 
these  conclusions  may  be  more  evident,  and  may  also  aid 
others,  who  may  be  desirous  of  checking  up  our  results  or 
of  continuing  our  investigations. 

The  father  of  Jane  Todd  Crawford  was  Samuel  Todd, 
who  was  the  sheriff"  of  Botetourt  County,  Virginia,  in 
1 79 1  and  1792.  Of  the  mother  of  Mrs.  Crawford  we  have, 
so  far,  been  unable  to  secure  any  trace.  The  family  of 
Samuel  Todd  consisted  of  six  daughters  and  two  sons. 
The  daughters  were  Lydia,  Jane,  Polly,  Ella  or  Alice, 
Sarah,  and  Hannah;  and  the  sons  were  John  and  Samuel. 
They  all  married  and  removed  to  Kentucky,  where  most 
of  them  reared  their  families  and  spent  their  lives.  Jane 
and  Sarah  migrated  to  Indiana,  where  they  died,  the 
former  at  Graysville  and  the  latter  at  Southport.  Hannah 
removed  to  Tennessee,  near  Knoxville.  The  family  Bible 
passed  into  the  hands  of  the  Rev.  James  Crawford,  the 
son  of  Jane  Todd  Crawford.  During  the  residence  of  the 
Rev.  James  Crawford,  at  Graysville,  a  fire  destroyed  his 
home  and  the  family  Bible  was  lost. 

In  our  efforts  to  trace  the  origin  of  the  Todd  family, 
a  task  that  represents  an  undertaking  in  genealogy  of  no 
small  proportion,  and  upon  which  some  of  its  members 
have  been  engaged  for  years,  we  encountered  in  the 
National  Encyclopedia  of  American  Biography,  Vol.  XIV, 
p.  204,  this  concise  statement: 

The  three  oldest  and  most  numerous  representatives  of  the 

Todd  family  in  America,  those  of  Virginia,  Connecticut  and 

Massachusetts,  all  emanate  from  the  West  Riding  of  Yorkshire, 

where  they  were  closely  related.    Robert  founded  the  Virginia 

family  in  1622. 

292 


JANE  TODD  CRAWFORD 

Although  Samuel  Todd,  the  former  sheriff  of  Botetourt 
County,  is  probably  a  descendant  of  this  Hne,  of  this  we 
have  so  far  failed  to  find  any  confirmation.  The  ex- 
act relationship  between  the  various  families  bearing 
this  name  is  beyond  the  province  of  this  work. 
Therefore,  we  are  unable  to  say  definitely  whether  or  not 
a  relationship  exists  between  the  family  of  Todds  who 
were  the  ancestors  of  our  heroine,  and  that  of  the  ancestors 
of  the  Todd  family  into  which  Abraham  Lincoln  married. 
By  some  of  the  Todds  it  is  claimed  that  these  families  are 
related,  and  by  others  the  relationship  is  denied. 

Unfortunately  the  same  incomplete  and  indefinite  state 
exists  with  reference  to  the  Crawford  side  of  the  house. 
In  a  recent  number  of  The  Journal  of  American  History, 
Vol.  XII,  No.  3,  the  origin  of  the  Crawford  family  is  given 
by  Mabel  Thacher  Rosemary  Washburn,  from  which  the 
following  abstract  was  prepared. 

Mabel  Thacher  Rosemary  Washburn. 

The  surname  of  Crawford,  which  represents  the  family 
that,  ever  since  the  period  of  the  Norman  Conquest,  has  held 
so  high  a  place  and  achieved  such  historic  distinction  in  the 
chronicles  of  Scotland,  is  derived  from  the  Barony  of  Crawford 
in  Lanarkshire. 

The  clear  pedigree  of  the  family  begins  with  one  Leofwine, 
whose  birth-date  cannot  be  placed  much  later  than  the  year 
looo.  He  was  evidently  of  Danish  blood  or  ancestry,  and  lived 
probably  in  that  part  of  England  known  a  thousand  years  ago 
as  Northumberland,  which  then  included  a  far  larger  territory 
than  the  present  English  County  of  the  name — Yorkshire, 
Lancashire,  and  Durham  being  then  a  part  of  the  Kingdom  of 
Northumbria,  in  which  the  Danish  element  was  strong  among 
the  population,  and  over  which,  up  to  the  Norman  Conquest, 
Dane-English  Earls  ruled  as  practically  independent  sovereigns. 
The  part  of  Northumberland  in  which  Leofwine  lived  was  per- 
haps Yorkshire,  for  in  the  Domesday  Survey  of  William  the 
Conqueror,  made  in  1086,  there  are  many  reference  to  Tor  or 

293 


EPHRAiM  McDowell 

Thor,  who  may  have  been  the  "Thor  Longus," — ^Thor  the  Tall — 
who  was  the  son  of  this  Leofwine.  Scottish  antiquarians  in  the 
Eighteenth  Century  had  discovered  the  existence  of  Thor 
Longus  as  an  ancestor  of  the  Crawford  family;  but  that  he  was 
the  son  of  Leofwine  is  first  made  known  in  this  present  paper, 
and,  for  that  reason,  the  evidence  of  the  relationship  is  herewith 
given  at  some  length. 

There  is  preserved  In  the  archives  of  the  Cathedral  of 
Durham,  among  the  documents  of  the  reign  of  King  Edgar,  the 
following  Charter  given  to  the  Cathedral  by  Thor  Longus, 
ancestor  of  the  second  known  generation  of  all  the  Crawfords 
of  Scotland  and  America: 

This  Charter  confirms  by  a  formal  statement  the  fact  that 
Edgar,  King  of  Scotland,  gave  to  Thor  Longus  the  land  of 
Ednaham,  then  a  waste,  unsettled  place,  which  Thor  Longus, 
partly  by  his  own  means  and  partly  by  the  aid  of  others,  colon- 
ized, and  on  which  he  built  a  church,  dedicated  to  God  and 
Saint  Cuthbert,  which  church,  together  with  one  "carrucate" 
of  land — about  one  hundred  acres — he  gave  in  perpetuity  to 
the  monks  of  Saint  Cuthbert,  that  is,  to  the  monks  connected 
with  Durham  Cathedral;  and  this  donation  was  made  as  an  act 
of  devotion  and  petition  for  the  blessing  of  God  upon  the  King, 
Edgar,  and  on  the  King's  parents,  "and  for  the  redemption  of 
Leofwine,  my  most  beloved  father,"  and  for  his,  Thor's,  own 
good  both  of  body  and  soul. 

It  is  probable  that  Leofwine  and  Thor  Longus  were  of 
mingled  Danish  and  Saxon  blood,  as  was  the  case  with  most  of 
the  Anglo-Danes  of  the  period. 

After  the  Conquest,  the  Northumbrian  nobles  refused  to 
submit  to  the  Norman  rule,  and  also  helped  to  harass  the  Con- 
queror's forces  by  joining  with  the  Danish  invaders  who  were 
then  seeking  new  footholds  in  the  land.  William  fought  fiercely 
against  the  Northumbrians  and  they  fought  back  as  fiercely. 
It  is  said  that  the  King,  using  his  favorite  oath,  "swore,  by  the 
Splendor  of  God,  that  he  would  not  leave  a  soul  alive.  And  .  .  . 
he  ravaged  their  country  .  .  .  that  for  sixty  miles  together  he 
did  not  leave  a  single  house  standing."    (Rapin,  I,  172.) 

Thor  Longus,  with  other  leaders,  was  expelled  from  North- 
umberland, or,  it  may  be,  went  voluntarily  to  join  the  armies 
of  the  King  of  Scotland  against  King  William.    The  exact  date 

294 


JANE  TODD  CRAWFORD 

of  his  settlement  in  Scotland  is  unknown.  It  is  believed  to  have 
been  between  the  years  1069  and  1074.  As  has  been  seen,  from 
the  Charter  to  the  monks  of  St.  Cuthbert,  he  received  lands  in 
Scotland  during  the  reign  of  King  Edgar,  1097  to  the  beginning 
of  1 107. 

Thus  may  be  placed,  at  the  head  of  the  Crawford  pedigree, 
Thor  the  Tall,  or  Thor  Longus,  son  of  Leofwine,  the  holder  of 
lands  in  Scotland  during  the  latter  part  of  the  Eleventh  Century. 
Edinham — 'TEdnaham  of  the  Charter  to  the  monks  of  St.  Cuth- 
bert— was  his  during  the  reign  of  King  Edgar.  It  is  in  the 
present  Shire  of  Roxburgh,  and  is  not  far  distant  from  Crawford. 

From  the  ancient  family  of  the  Crawfords  of  Ayrshire, 
Scotland,  came  to  America  John  Crawford,  first  of  his  line 
in  this  country.  It  is  believed  that  he  arrived  in  Massachusetts 
about  1672.  From  Massachusetts  he  went  to  Long  Island,  later 
making  his  home  in  Middletown,  Monmouth  County,  New 
Jersey.  He  was  in  Middletown  by  1678,  when  on  December  ii 
of  that  year,  Richard  Gibbons  and  his  wife  deeded  to  John 
Crawford  a  house  and  land  in  Middletown.  That  same  year  he 
was  granted  license  for  maintaining  an  ordinary  or  tavern  at 
Middletown.    He  bought  large  tracts  of  land. 

Again,  we  are  unable  to  prove  definitely  that  the  Craw- 
fords with  whom  we  are  dealing  descended  from  the  fore- 
going house,  although  this  claim  has  been  made. 

Jane  Todd  Crawford,  who  so  justly  deserves  to  share 
with  Ephraim  McDowell  the  honor  and  glory  of  the  first 
ovariotomy,  was  born  in  Rockbridge  county  on  the  23rd 
of  December,  and  in  our  beUef  in  the  year  1763. 
Most  likely  she  lived  out  her  seventy-eighth  year  and 
was  in  her  seventy-ninth  year,  as  the  inscription  on  her 
tombstone  suggests.  In  this  event  the  year  of  her  birth 
would  be  1763.  Some  have  given  the  date  of  her  birth 
as  1761,  but  this  is  probably  an  error,  as  it  would  make 
her  more  than  eighty  years  of  age  at  the  time  of  her  death. 

Since  the  Mitchells,  to  whom  she  was  related,  and  with 
whom  the  Crawfords  migrated  to  their  future  home  in 
Green  County,  Kentucky,  lived  in  Rockbridge  County, 

295 


EPHRAiM  McDowell 

Virginia,  at  the  junction  of  Buffalo  and  Broadcreek, 
about  six  miles  from  Lexington,  it  is  reasonable  to 
assume  that  the  Crawfords  possibly  lived  somewhere  in 
the  same  vicinity. 

It  is  deserving  of  comment  that  the  homes  of  both  the 
hero  and  the  heroine,  from  the  time  of  their  births,  to  a 
brief  period  after  the  operation,  were  never  more  than  a 
short  distance  apart.  Of  her  early  life  even  less  is  known 
than  of  McDowell's,  but  it  is  entirely  reasonable  to  sup- 


The  Crawford  Cabin  in  Green  County,  Kentucky 

pose  that  it  was  as  commonplace  as  that  of  any  of  those 
simple,  modest  country  folk  who  lived  in  this  pic- 
turesque and  fertile  frontier  section  of  our  young  but 
growing  country. 

From  one  of  the  letters  of  Mr.  J.  K.  Mitchell,  we  learn 
that  Thomas  Crawford  married  Jennie  or  Jane  Todd, 
January  9th,  1794,  the  Reverend  Sam  Houston  officiating. 

Thomas  Mitchell,  who  was  born  on  June  i6th,  in  the 
year  1768,  in  Virginia,  and  who  on  February  12,  1799, 
married  Rachel,  the  sister  of  Thomas  Crawford,  joined 
with    the    Crawfords,    Thomas    and    Jane,    when    they 

296 


JANE  TODD  CRAWFORD 

migrated  to  Green  County,  Kentucky,  in  the  year 
1805.  The  dangers  from  the  Indians  were  not  entirely 
over,  and  for  that  reason  as  well  as  on  account  of  the 
hardships  and  difficulties  common  to  a  wild  and  un- 
developed state,  immigrants  were  inclined  to  move  about 
not  singly  but  in  groups.  They  settled  nine  miles  south- 
east of  Greensburg,  the  county  seat  of  Green  County,  at 
the  former  post  office  of  Camp  Knox,  arriving  there 
November  5,  1805. 

The  Crawford  home  was  located  on  the  Blue  Spring 
branch  of  the  waters  of  Caney  Fork.  From  Mr.  J.  A. 
Mitchell,  who  lived  on  the  Crawford  farm,  and  who  kindly 
examined  the  records,  we  learn  that  Thomas  Crawford 
and  his  wife,  Jane,  transferred  to  John  Motley,  four  hun- 
dred and  twenty-seven  acres  of  land  for  $1900  *'Cash  in 
hand,"  on  December  8,  18 10.  This  was  one  year  after 
the  operation.  The  land  was  afterwards  known  as  Mot- 
ley's Glen.  Mrs.  Crawford  had  been  living  there  for  about 
four  years  prior  to  the  operation. 

There  were  five  children  born  of  the  union  of  Thomas 
and  Jane  Todd  Crawford,  and  all  before  the  operation. 
There  were  no  children  born  after  the  ovarian  operation. 
The  children  included  three  sons  and  two  daughters,  one 
of  whom  died  while  young,  and  by  some  has  been  over- 
looked. Those  that  survived  are  James  Crawford,  born 
November  23,  1794,  who  became  a  Presbyterian  minister; 
Alice  Crawford,  born  April  20,  1797,  who  married  William 
Paul  Brown;  Samuel  Crawford,  who  was  born  February 
21,  1799;  and  Thomas  Howell  Crawford,  the  youngest, 
who  was  born  March  i,  1803.  Of  the  daughter  who  died 
while  young  there  is  no  available  data,  and  some  even 
doubt  that  there  was  a  fifth  child. 

When  the  Crawfords  left  the  vicinity  of  Greensburg 

297 


EPHRAiM  McDowell 

in  1 8 10,  a  year  after  the  operation,  it  is  not  definitely 
known  whether  or  not  they  moved  directly  to  Indiana. 

There  are  several  more  or  less  vague  references  that 
would  incline  one  to  the  belief  that  they  did  not  move 
directly  there,  but  for  a  time  lived  on  the  Kentucky  side 
of  the  Ohio  River,  about  opposite  their  first  Indiana  home. 
At  least  there  is  a  gap  of  seven  years  between  the  time 
that  they  left  Green  County  and  the  time  of  their  settle- 
ment in  Jefferson  County,  Indiana,  and  it  was  during  this 
time  most  likely  that  they  lived  in  Kentucky,  just  across 
the  river  from  Madison. 

Why  they  became  dissatisfied  with  Green  County 
and  moved  to  Indiana  Is  not  known,  unless  the  sug- 
gestions in  some  of  Mr.  J.  K.  Mitchell's  letters  answer 
the  question. 

Speaking  of  Thomas  Crawford  he  says: 

He  must  have  been  rather  an  exception  as  a  business  man  to 
acquire  the  property  he  did  in  that  early  day,  as  he  was  a  slave 
owner  as  well  as  a  large  land  owner  in  Kentucky.  He  left 
Kentucky  on  account  of  his  conscientious  convictions  against 
slavery,  and  instead  of  selling  his  slaves,  he  set  them  all  free. 
(Letter  of  February  21,  19 13.) 

In  the  next  letter  he  says: 

The  statement  that  he  left  Kentucky  on  account  of  his 
convictions  on  slavery  is  also  a  tradition  in  the  family.  I  do  not 
know  any  authority  for  it  other  than  this  tradition.  I  never 
heard  of  it  in  my  boyhood.  I  lived  with  Uncle  John  Mitchell, 
Green  County,  Kentucky,  who  was  a  very  strong  anti-slavery 
man  and  was  called  an  abolitionist  in  old  days,  but  he  never 
said  much  about  Thomas  Crawford.    (Letter  of  March  12, 1913.) 

In  1817  the  Crawfords  moved  to  Indiana,  settling  In 
Jefferson  County  just  outside  of  the  city  of  Madison. 
Here  Thomas  Crawford  lived  until  his  death  In  1830.  At 
the  time  of  their  arrival,  the  land  on  which  they  settled 

298 


JANE  TODD  CRAWFORD 

was  in  a  primitive  and  uncleared  state.  Through  the 
clearing  of  this  land  he  lost  his  life.  He  stepped  out  one 
night  to  watch  the  burning  brush,  and  while  moving 
about,  fell  into  a  cellar-way  and  was  instantly  killed. 
Thomas  Crawford  represented  Jefferson  County  in  the 
Indiana  legislature  that  convened  November  27,  1820, 
and  adjourned  January  9,  1821.  His  grandson,  the 
late  Mr.  James  C.  Brown,  of  Morning  Sun,  Iowa,  in- 
formed us  that  after  the  death  of  his  grandfather,  the 
farm  passed  into  the  hands  of  his  father,  Mr.  William 
Paul  Brown. 

His  grandmother,  the  heroine,  continued  for  a  number 
of  years  to  make  her  home  with  her  daughter,  Alice  Craw- 
ford Brown.  After  the  lapse  of  some  years  she  left  the 
home  of  her  daughter,  whose  family  still  resided  on  the 
farm,  and  moved  to  the  home  of  her  son,  who  lived  at 
Graysville,  Indiana.     She  died  at  this  place. 

In  our  research  evidences  were  discovered  indicating 
that  she  may  at  one  time  have  lived  in  a  settlement  on 
the  Wabash  River,  presumably  Logansport,  and  also  in 
Bloomington,  Indiana. 

The  reference  bearing  upon  her  residence  in  a  settle- 
ment on  the  Wabash  occurs  in  Dr.  S.  D.  Gross'  report, 
"Report  of  the  Committee  on  Surgery."  Trans.  Ky. 
State  Med.  Soc,  1853,  to-wit: 

It  will  not  be  uninteresting  here  to  state  that  Mrs.  Craw- 
ford, at  the  time  of  the  operation  performed  upon  her  by  Doctor 
McDowell,  lived  in  Green  county,  Kentucky,  from  whence  she 
removed,  sometime  afterwards,  to  a  settlement  on  the  Wabash 
River  in  Indiana,  where  she  died,  March  30,  1841,  in  the  seventy- 
ninth  year  of  her  age.  There  was  no  return  of  her  disease,  and 
she  generally  enjoyed  excellent  health  up  to  the  period  of  her 
death.  She  had  no  issue  after  the  operation.  Her  youngest 
child,  our  worthy  citizen,  Mr.  Thomas  H.  Crawford,  who  has 

299 


EPHRAiM  McDowell 

kindly  communicated  to  me  these  facts,  was  born  in   1803, 
nearly,  or  quite,  six  years  before  the  operation. 

This  would  suggest  a  possible  residence  with  her  son, 
Samuel,  who  lived  in  Logansport  on  the  Wabash,  and  who 
died  in  the  year  1843.  Or  she  may  have  lived  for  a  time 
with  her  son  Samuel  before  taking  up  her  residence  with 
her  son,  the  Rev.  James  Crawford,  at  Graysville,  the 
place  where  she  passed  away. 

The  clew  indicating  that  she  may  at  one  time  have 
resided  in  Bloomington,  Indiana,  occurs  in  the  "  Report 
of  Improvements  in  Art  and  Science  of  Surgery,"  by 
Joseph  N.  McDowell,  read  before  the  American  Medical 
Association,  i860.  It  is  in  the  form  of  a  letter  in  answer 
to  Dr.  Joseph  N.  McDowell's  inquiry:  To  whom  is  the 
credit  of  the  first  ovariotomy  due.?  The  heading  reads 
Bloomington,  Indiana,  August,  1824. 

The  only  suggestion  that  we  met  bearing  upon  her 
appearance  came  from  her  grandson,  James  C.  Brown, 
and  this  is  but  a  meagre  description.  He  briefly  says, 
"As  I  remember  her,  she  was  of  medium  height,  and 
weighed  probably  200  pounds  or  more."  As  daguer- 
reotypes were  not  introduced  into  the  United  States 
until  shortly  before  her  death,  it  is  not  likely  that  any 
photograph  of  her  was  ever  taken,  and  still  more  unlikely 
is  the  idea  of  a  portrait.  Hence  we  may  abandon  the 
thought  of  ever  securing  a  likeness  of  this  woman  whose 
life  meant  so  much  to  succeeding  generations. 

Her  children  became  worthy  members  of  the  communi- 
ties in  which  they  resided.  The  youngest,  Hon.  Thomas 
Howell  Crawford,  occupied  the  chair  of  the  Chief  Magis- 
trate of  Louisville,  in  1859-60. 

From  a  personal  letter  of  Judge  James  S.  Pirtle  we 
take  the  following  tribute  to  her  son: 

300 


Hon.  Thomas  Howell  Crawford,  who  served  as  Mayor  of  Louisville  in  18SO-60. 
He  was  the  youngest  of  the  family  of  Thomas  and  Jane  Todd  Crawford. 


JANE  TODD  CRAWFORD 

Hon.  Thomas  H.  Crawford  was  Mayor  of  Louisville  in 
1859-60.  He  was  no  doubt  often  a  member  of  the  City  Council. 
His  upright  character,  industry  and  business  ability  made  him 
prominent  and  commanded  the  confidence  of  his  fellow  citizens. 
After  i860  he  was  principally  occupied  in  the  management  of 
estates  committed  to  him  by  the  County  Court  as  administrator, 
or  executor,  or  guardian.  Mr.  Crawford  was  a  large  man  with 
a  large,  rather  bald  head,  smooth  shaven,  a  very  benevolent 
and  intelligent  countenance,  very  neat  in  his  address  and  of 
quiet  manners.  I  suppose  he  must  have  lived  to  65  years  of 
age.  He  had  his  home  in  the  country,  at  Pewee  Valley,  I  think. 
His  home  was  lighted  by  gas.  There  was  something  wrong  with 
the  gas  machine,  and  he  and  a  member  of  the  family  went  into 
the  cellar  to  see  about  it.  An  explosion  occurred.  Both  of  the 
persons  were  burned,  and  Mr.  Crawford  fatally.  (Letter  of 
November  13,  1912.) 

His  tragic  death  bears  a  strange  resemblance  to  that 
of  his  father,  who  also  lost  his  life  through  an  accident. 

A  critical  inquiry  failed  to  throw  any  light  upon  the 
attitude  that  Mrs.  Crawford  assumed  towards  the  oper- 
ation, other  than  that  reflected  in  her  actions.  All 
details  relating  thereto  are  lost.  The  conclusion  that 
is  scarcely  avoidable  is  that  after  hearing  a  frank 
statement  of  her  condition,  and  realizing  the  hopelessness 
of  the  outlook,  and  the  rapidly  approaching  invalidism, 
she  did  just  what  would  be  expected  of  any  well-balanced, 
courageous  woman.  She  submitted  and  took  her  chances 
in  a  throw  in  which  she  had  nothing  but  a  painful  state  of 
invalidism  to  lose,  and  reasonable  chances  to  gain  an 
extended  lease  on  life. 

Her  judgment  was  as  good  as  McDowell's,  and  her 
courage  and  fortitude  were  the  equal  of  his  courage 
and  genius;  and  why  they  should  not  evenly  divide 
the  honors,  we  are  unable  to  understand.  It  seems 
but  reasonable  and  equitable  to  consider  any  and  every 

301 


EPHRAiM  McDowell 

movement  that  involves  the  honoring  of  Ephraim  Mc- 
Dowell without  correspondingly  honoring  Jane  Todd  Craw- 
ford as  unjust  and  incomplete. 

No  attempt  at  evasion,  based  upon  the  thought  that 
she  submitted  to  escape  a  distressful  and  otherwise  fatal 
condition  in  which  she  found  herself,  and  that  she  yielded 
as  a  last  resort,  or  anything  akin  to  these  suggestions 
can  possibly  be  justified  if  we  fully  and  fairly  consider  her 
claims.  Neither  operator  nor  patient  at  the  time  had  the 
remotest  conception  of  the  significance  and  importance  of 
the  step.  Each  was  inseparable  from  the  other  in  its  perfor- 
mance, hence  they  both  deserve  the  eternal  gratitude  of 
posterity,  and  some  adequate  expression  of  this  debt  of 
gratitude  and  this  honor  which  has  been  so  grossly  ignored 
and  so  ungratefully  withheld. 

Through  the  kindness  of  Mr.  J.  A.  Mitchell,  we  secured 
a  sketch  of  the  humble  log  cabin  where  Mrs.  Crawford 
resided  when  McDowell  was  called  into  the  consultation 
over  her  condition.  From  this  sketch  the  accompanying 
plate  was  prepared. 

The  Crawfords  did  not  arrive  at  their  first  home  in 
Kentucky  until  the  beginning  of  November  in  the  year 
1805.  Owing  to  the  slowness  and  difficulties  that  attended 
the  construction  of  the  simplest  log  cabin  in  those  early 
days,  it  is  generally  assumed  that  they  did  not  erect  this 
cabin,  but  that  it  was  in  existence  at  the  time  of  their 
arrival.  It  was  located  on  the  Blue  Spring  branch  of 
Caney  Fork,  a  stream  that  derived  its  name  from  the 
cane  growth  that  abounded  in  that  region.  The  Burkes- 
ville  and  Greensburg  road  ran  along  the  side  of  the  cabin. 
The  old  road  was  partly  in  the  gravel  bed  of  the  Blue 
Spring  branch.  Some  time  between  1840  and  1850  the 
old  road  was  shifted  to  the  opposite  side  of  the  cabin. 

302 


JANE  TODD  CRAWFORD 

The  crops  were  principally  wheat  and  tobacco,  and 
the  timber  was  of  the  blue  ash  variety.  The  cabin  was 
constructed  from  this  timber,  and  the  crevices  between 
the  logs  were  "pointed"  with  lime,  giving  the  whole  a 
striped  and  somewhat  embelHshed  appearance.  The  farm 
was  located  about  nine  miles  southeast  of  Greensburg 
at  the  former  postoffice,  known  as  Camp  Knox,  but 
since  the  estabHshment  of  the  rural  delivery  this  office 
has  been  discontinued.  When  sold  to  John  Motley,  a 
year  after  the  operation,  the  farm  reahzed  four  and  a 
fraction  dollars  per  acre. 

There  is  a  tradition  in  the  Mitchell  family  that 
McDowell  made  no  charge  for  the  operation,  but  that  Mr. 
Crawford  presented  him  with  an  honorarium.  The  sum 
mentioned  (^looo.oo)  was  so  large,  however,  that,  con- 
sidered in  the  light  of  that  period  and  the  financial  status 
of  the  contracting  parties,  it  is  out  of  reason  to  suppose 
the  story  as  credible. 

The  McDowells  and  the  Crawfords  were  highly  re- 
spected members  of  their  communities,  and  while  the 
country  watered  by  Caney  Fork  in  Green  County  can 
in  no  way  be  compared  to  Danville,  even  when  it  was  a 
mere  village,  it  is  reasonable  to  assume  that  the  contract- 
ing parties  to  the  memorable  and  all-important  surgical 
procedure  reached  an  agreement  that  was  mutually  satis- 
factory, but  most  likely  was  by  no  means  what  the  tradi- 
tion in  the  Mitchell  family  suggests. 

From  all  accounts  Mrs.  Crawford's  health  was  fully 
restored,  and  she  continued  in  this  satisfactory  state  for 
the  remainder  of  her  life.  This  covered  a  period  of  thirty- 
three  years.  As  to  the  nature  of  her  last  illness,  its  dura- 
tion, and  other  details,  we  are  unable  to  speak.  Nor  has 
the  cause  of  her  death  or  the  exact  year  of  her  passing 

303 


EPHRAiM  McDowell 

been  definitely  settled.  The  latter  has  variously  been 
given  as  1841,  1842  and  1843;  most  likely,  it  is  as  recorded 
on  the  tombstone,  1842.  The  family  Bible  in  which  it 
was  customary  to  preserve  such  records  was  in  the  keeping 
of  her  son,  as  we  have  said,  and  was  lost  during  a  fire  that 
destroyed  the  home  of  the  Rev.  James  Crawford.  Gross 
refers  to  the  year  in  which  she  died  as  1841,  and  gives 
her  youngest  son,  the  Hon.  Thomas  Howell  Crawford, 
as  his  authority.  Notwithstanding  this,  the  date  which 
the  tombstone  bears  is  more  likely  to  be  the  correct 
one,  and  furthermore  has  the  support  of  most  of  the  de- 
scendants who  have  ventured  an  opinion  upon  this  ques- 
tion. Mr.  James  C.  Brown,  of  Morning  Sun,  Iowa,  in  an- 
swering a  questionnaire  gave  1843  as  the  year  of  her  death. 

By  far  the  most  important  result  of  the  investigations 
upon  the  life  of  Mrs.  Crawford  was  the  finding  of  her  grave 
in  Johnson  Cemetery  near  Graysville,  Indiana.  The  story 
of  this  achievement  is  as  interesting  and  fascinating  as 
any  novel,  and  the  patience  and  persistence  of  the  finder 
compare  favorably  with  the  best  efforts  of  the  most  suc- 
cessful investigators  In  any  other  field  of  inquiry. 

Properly  to  identify  Jane  Todd  Crawford,  who  for 
more  than  a  century  had  been  handed  about  from  writer 
to  writer  as  Mrs.  Crawford  of  Green  County,  until  the 
thought  of  establishing  for  her  the  slightest  measure  of 
identification  seemed  an  utterly  hopeless  undertaking,  was 
in  itself  an  accomplishment  that  many  considered  impos- 
sible. We  naturally  feel  gratified  over  the  success  that 
attended  these  efforts,  but  difficult  as  it  was  to  bring  some 
degree  of  order  and  identification  out  of  this  obscurity, 
it  was  after  all  commonplace  In  comparison  with  the  suc- 
cess that  attended  the  location  of  the  grave  of  this  all-but- 
forgotten  woman  in  a  small  obscure  cemetery  In  the  State 

304 


JANE  TODD  CRAWFORD 

of  Indiana.  As  we  have  said  before  the  credit  for  this 
unusual  feat  is  due,  in  our  judgment,  wholly  to  the  patient 
efforts  of  Mr.  J.  Knox  Mitchell,  of  Osborne,  Kansas. 
Without  his  co-operation  the  grave  in  all  probability 
would  have  remained  in  obscurity.  In  fact  it  would  be  un- 
reasonable to  expect  anyone,  not  familiar  with  the  history 
of  Mrs.  Crawford  and  not  interested  therein,  to  attach  any 
importance  to  her  tombstone  if  he  saw  it  by  chance.  The 
name  of  Crawford  is  a  rather  common  one,  and  there  is 
no  reason  why  anyone  should  suspect  such  a  common- 
place tombstone  in  such  an  obscure  cemetery  as  bemg 
of   any  undue  significance. 

It  would  only  have  meaning  to  a  finder  who  was 
familiar  with  the  life  of  Mrs.  Crawford,  and  who  was 
interested  in  tracing  her  movements.  Only  such  a  person 
could  grasp  the  possible  historic  importance  of  this  tomb- 
stone. It  was  because  Mr.  Mitchell  fulfilled  these  quali- 
fications that,  through  co-operating  with  and  directing  the 
movements  of  others,  the  grave  was  discovered. 

For  a  time  a  little  confusion  existed  as  to  who  was 
entitled  to  the  credit.  This  confusion  arose  largely 
through  the  remoteness  of  Mr.  Mitchell  from  the  sphere 
of  investigation.  Being  in  Kansas,  far  removed  from  the 
scene  of  action,  he  was  unintentionally  overlooked  by 
those  who  became  interested  in  the  search,  and  until  it 
was  made  clear  that  the  search  was  instigated  and  directed 
wholly  from  Kansas,  some  members,  who  aided  but  were 
unaware  of  the  directing  hand,  inadvertently  ignored  the 
credit  due  Mr.  Mitchell. 

In  view  of  this  and  the  exceptional  result  it  seems 
proper  to  trace  the  steps  and  publish  the  correspondence, 
showing  clearly  how  the  discovery  was  effected.  From 
Mr.  J.  K.  Mitchell's  letter  of  November  29,  191 2,  we 

20  305 


EPHRAiM  McDowell 

reproduce  the  first  half,  which  is  germane  to  the  subject 
and  reveals  the  earliest  intimations  of  Mr.  Mitchell's 
intention  to  discover,  if  possible,  the  grave  of  the  heroine. 

Osborne,  Kansas. 

Il/29/'l2. 

Dr.  August  Schachner, 

Louisville,  Ky. 
My  Dear  Doctor: 

I  will  enclose  you  herewith  a  very  Interesting  letter  from 
Rev.  A.  E.  Cameron,  Pastor  of  the  Presbyterian  Church  at 
Morning  Sun,  Iowa.  This  is  the  place  at  which  the  Rev.  James 
Crawford  died,  who  was  a  son  of  Mrs.  Jane  Crawford,  whose 
history  we  are  tracing. 

The  letter  also  shows  that  Amelia  Crawford  has  two  first 
cousins  living  at  Morning  Sun,  Iowa,  In  the  persons  of  James 
Crawford  Brown  and  his  sister  Miss  Martha  Brown.  Miss 
Crawford  supposed  that  these  persons  were  dead  and  had  dis- 
appeared, but  you  will  see  they  are  still  In  reach.  I  have  not 
heard  from  them  yet,  but  I  will  get  their  story  with  all  that  they 
can  recollect  concerning  their  grandmother.  I  think  we  shall 
probably  find  where  and  when  she  died,  and  where  she  Is  burled. 
That  Is  what  I  am  anxious  to  ascertain.  We  shall  probably 
find  that  her  remains  rest  In  an  unmarked  grave  and  we  may 
not  be  able  to  distinguish  the  grave  at  this  date.  I  have  written 
to  Rev.  Cameron  that  my  only  connection  with  the  matter  is 

in  aiding  you  to  get  at  the  facts 

(Signed)       J.  K.  Mitchell. 

From  Morning  Sun,  Iowa,  Mr.  Mitchell  transfers  his 
inquiry  to  Sullivan,  Indiana,  to-wit : 

I2/6/'l2. 

Rev.  John  McArthur, 

Sullivan,  Indiana. 
My  Dear  Sir: 

I  took  your  name  from  the  minutes  General  Assembly  of 
the  Presbyterian  Church  for  the  year  1912  as  the  Presbyterian 
Minister  at  Sullivan,  Ind. 

306 


JANE  TODD  CRAWFORD 

I  wish  to  get  some  information  concerning  the  grave  of 
Mrs.  Jane  Crawford,  who  died  at  Graysville,  Indiana,  in  the  year 
1843.  She  was  residing  at  the  time  of  her  death  with  her  son. 
Rev.  James  Crawford.  Rev.  James  Crawford  I  understand  was 
a  Presbyterian  minister  and  spent  sometime  in  colportage  work, 
afterwards  removed  to  the  State  of  Iowa  and  died  at  Morning 
Sun,  Iowa,  in  July,  1872,  and  I  am  assisting  a  Physician  of 
Louisville,  Ky.,  in  finding  out  the  facts  regarding  this  Mrs. 
Jane  Crawford's  place  of  death  and  burial.  There  seems  to  be 
no  Presbyterian  Church  at  Graysville,  Indiana,  now,  but  I 
thought  that  there  might  be  some  Presbyterians  in  that  vicinity 
or  someone  else  that  would  aid  me  in  my  search.  I  wish  to  find 
out  if  possible  the  grave  of  Mrs.  Crawford.  It  happened  that 
she  was  the  first  woman  in  the  human  history  upon  whom  the 
operation  known  as  ovariotomy  was  performed  in  the  year  1809. 
She  then  resided  in  Green  County,  Ky.,  but  afterwards  removed 
to  Graysville.  I  am  very  anxious  to  find  out  if  I  can  a  record 
of  the  date  of  her  death  and  burial  and  her  grave  if  possible. 
If  you  know  anyone  in  Graysville  or  vicinity  that  would 
likely  aid  me  in  getting  this  Information  I  will  thank  you  very 

much 

(Signed)     J.  K.  Mitchell. 

The  letters  of  the  Rev.  John  H.  McArthur  which  we 
were  permitted  to  copy,  and  which  are  the  outcome  of  the 
foregoing  letter  of  inquiry,  add  two  important  links  to  our 
story.    They  are  as  follows: 

Copy  213  N.  Main  St., 

Sullivan,  Ind., 

Dec.  II,  1912. 

Mr.  J.  K.  Mitchell, 

Osborne,  Kansas. 

Dear  Mr.  Mitchell: 

I  am  In  receipt  of  your  letter  of  inquiry  of  6th  ult.  Several 
of  the  other  people  of  Sullivan  remember  the  Rev.  James  Craw- 

307 


EPHRAiM  McDowell 

ford  of  whom  your  letter  speaks,  but  I  have  not  at  this  writing 
found  any  one  who  remembers  anything  either  from  personal 
knowledge  or  from  tradition  of  Mrs.  Jane  Crawford,  the  mother. 
The  cemetery  in  which,  doubtless,  she  was  buried,  is  still  being 
used,  and  is  located  near  the  farm  upon  which  her  son  James 
Crawford  lived,  about  four  miles  from  the  village  of  Graysville. 
A  church  formerly  stood  on  this  plot,  the  church  served  by  Mr. 
Crawford  up  to  the  time  of  his  removal  to  Iowa. 

I  have  written  parties  at  Graysville  who  may  be  able  to 
give  me  further  information.  I  will  make  an  effort  to  ascertain 
whether  or  not  Mrs.  Crawford's  grave  can  be  identified.  Will 
also  find  out  if  the  old  church  records  are  available.  If  they  are 
available,  I  can  doubtless  get  some  facts  from  them. 

I  will  write  you  as  soon  as  I  have  anything  to  report.  Grays- 
ville is  a  little  village  of  about  200  people,  located  ten  miles 
from  Sullivan.  A  Presbyterian  Church,  made  up  in  part  of 
members  from  the  old  church  in  the  Country,  was  maintained 
there,  until  four  years  ago  when  it  was  disbanded,  and  most  of 
the  members  who  belonged  to  the  3rd  Generation  after  Mrs. 
Jane  Crawford,  united  with  the  Church  at  Sullivan. 

Very  sincerely, 

(Signed)     John  H.  McArthur. 

Copy 

213  N.  Main  St., 
Sullivan,  Ind., 

Dec.  16,  1912. 

Mr.  J.  K.  Mitchell, 
Osborne,  Kansas. 

Dear  Sir: 

Yours  of  the  13th  ult  received  this  a.m.  I  have  been  able 
to  secure  the  following  facts  relating  to  the  death  &  grave  of 
Mrs.  J.  Crawford. 

Her  grave  Is  In  what  Is  known  as  the  "Johnson  Cemetery," 
about  4  miles  from  the  little  village  of  Graysville,  Ind.  It  Is 
marked  by  a  small  marble  slab,  bearing  the  following  inscription: 

308 


Grave  and  tombstone  of  Jane  Todd  Crawford,  in  Johnson  Cemetery  near  Graysville, 
Indiana.      Secured  through  the  kindness  of  W.  N.  Thompson,  M.  D.,  of  Sullivan,  Ind. 


JANE  TODD  CRAWFORD 

Jane  Crawford 
Died 

March  30,  1842 
Aged  75  years     (Typographical  error.) 

In  the  same  cemetery  is  also  found  the  grave  of  the  wife  of 
Rev.  James  Crawford,  marked  by  a  slab  bearing  the  inscription: 

Ann  Marie 

wife  of 

Rev.  James  Crawford 

Died 

April  4,  1852 

Aged  59  years 

In  my  inquiries  I  have  found  that  the  Medical  Association 
of  Sullivan  County  has  been  making  some  investigation  of  this 
matter.  If  you  can  do  so,  you  might  communicate  with  Dr.  B. 
Maple,  Shelburn,  Ind.,  who  is,  I  think,  the  Sec.  of  Ass. 

I  might  add  that  the  cemetery  is  still  being  used,  but  is 
under  the  control  of  no  corporation  or  association,  and  is  prob- 
ably not  kept  in  very  ....  condition. 

Sincerely, 

Copy  (Signed)     John  H.  McArthur. 

The  McArthur  letters  are  better  understood  after  read- 
ing the  following  extract  from  Mr.  Mitchell's  letter  of 
January  14,  191 3: 

The  facts  are  these:  on  December  6,  1912, 1  wrote  Rev.  John 
H.  McArthur,  Presbyterian  Minister  at  Sullivan,  Ind.,  telling 
him  that  Mrs.  Jane  Crawford  died  at  Graysville,  Ind.,  and  re- 
questing him  to  aid  me  in  finding  her  grave.  I  received  an 
answer  from  him  dated  December  11, 1912,  and  later  received  a 
letter  dated  December  16,  1912,  giving  me  exact  place  of  her 
burial  and  inscription  on  her  tombstone.  I  will  enclose  you  these 
letters,  which  kindly  read  and  return  to  me.  A  letter  from  me  to 
Dr.  O.  O.  Parker  dated  December  7,  1912,  remained  unanswered 
till  June  8,  1913,  but  on  December  20,  1912,  I  wrote  to  Dr.  B. 

309 


EPHRAiM  McDowell 

Maple,  Sec.   Sullivan  Co.  (Ind.)   Medical  Association  telling 
him  exactly  where  Mrs.  Crawford's  grave  was. 

In  Mr.  Mitchell's  letter  of  January  20  1913,  we  have 
his  most  interesting  contribution  to  the  story.  This  is 
really  a  resume  of  his  efforts.    He  says : 

The  way  that  I  came  to  find  that  Mrs.  Crawford  died  at 
Graysville  was  that  I  traced  her  son  Rev.  James  Crawford 
through  the  Minutes  of  the  Presbyterian  General  Assembly 
from  the  time  he  began  the  ministry  up  until  the  time  of  his 
death.  I  found  that  he  had  lived  at  Graysville,  Indiana,  and 
that  he  died  at  Morning  Sun,  Iowa,  and  then  by  correspondence 
with  these  descendants  in  Morning  Sun,  Iowa,  I  ascertained  that 
Jane  Todd  Crawford  died  at  the  home  of  Rev.  James  Crawford 
when  he  lived  at  Graysville,  Indiana.  Then  it  occurred  to  me 
that  she  was  very  likely  buried  at  Graysville  or  in  that  vicinity, 
so  I  looked  up  the  name  of  the  Presbyterian  minister  at 
Sullivan,  Indiana,  and  wrote  him,  as  I  found  from  the  same 
minutes  that  the  Presbyterian  Church  at  Graysville,  Indiana, 
had  been  discontinued.  In  this  way  I  located  the  grave  in  the 
cemetery  near  Graysville.  I  presume  that  Rev.  McArthur 
made  the  first  suggestion  to  the  local  physicians,  which 
aroused  them  to  look  into  the  matter  and  make  the  photo- 
graph of  the  grave  which  appeared  in  the  Journal  of  the 
American  Medical  Association. 

From  this  evidence  the  details  of  the  patient  and  per- 
sistent labor  of  Mr.  Mitchell  become  apparent,  and  too 
much  praise  cannot  be  accorded  him  for  his  worthy  efforts 
that  were  attended  with  such  brilHant  success.  For  the 
efforts  of  those  co-workers  about  Sullivan  who  so  kindly 
co-operated  and  who  were  so  enthusiastically  interested 
in  the  search,  we  all  owe  a  debt  of  gratitude  which  we 
most  cheerfully  acknowledge. 

Meagre  as  this  history  of  Mrs.  Crawford  is,  considering 
the  discouraging  outlook  that  confronted  us  in  the  begin- 
ning of  our  task,  we  feel  gratified  in  having  secured  even 
these  details.    We  hope  that  they,  at  least,  will  serve  as  a 

310 


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nucleus  and  stimulus  for  others  to  enlarge  upon,  and  that 
they  will  tend  to  arouse  and  sustain  an  interest  that  will 
have  as  its  culmination  an  adequate  recognition  of  the 
debt  that  the  human  race  owes  this  benefactress. 

Since  the  rights  of  women,  which  have  so  long  been 
overlooked,  are  now  being  generally  recognized,  may  we 
not  expect  to  see  some  signs  of  an  appreciation  from  her 
own  sex?  It  is  so  entirely  fair  to  assume  that  these  in- 
creasing rights  of  women  spell  increasing  obligations  that 
we  are  persuaded  to  hope  that  some  member  of  her  sex 
endowed  with  the  necessary  resources  will  recognize  this 
as  an  opportunity  to  honor  herself  and  her  sex  as  well  as 
to  fulfill  a  long-neglected  public  duty. 

During  the  Great  World  War  that  shook  the  entire 
globe,  every  one,  doubtless,  was  impressed  with  the 
sacrifices  made,  not  in  one  country,  but  in  every  country 
— not  upon  one  side,  but  upon  both  sides  of  the  conflict. 
Indeed,  it  is  impossible  for  anyone  who  gives  the  sub- 
ject but  a  moment's  reflection  to  fail  to  be  impressed  with 
the  sacrifices  in  every  war,  sacrifices  that  are  made  in  both 
good  and  bad  causes,  for  both  cannot  be  in  the  right,  and 
the  earnestness  is  as  intense  on  the  one  side  as  on  the  other. 
Since  the  psychology  of  war  is  based  upon  the  emo- 
tionalism in  human  nature  that  has  so  frequently  and 
successfully  been  aroused,  should  we  not  be  reminded 
that  we  owe  at  least  as  much  to  the  heroism  of  peace, 
which  lacks  this  emotional  stimulus,  as  we  do  to  the 
heroism  of  war? 

If  we  consider  the  oft  referred  to  crimes  that  have  been 
committed  in  the  name  of  patriotism,  we  are  tempted  to 
suggest  that  the  heroes  and  heroines  of  peace  be  given 
the  preference. 

Aside  from  the  commendable  wars  of  liberation,  which 

311 


EPHRAiM  McDowell 

are  largely  revolutionary  in  character,  and  those  purely 
defensive  against  outside  aggression,  wars  as  a  rule  have 
as  their  basis  sordid  greed  which  collectively  considered 
is  called  national  imperialism,  and  individually  considered 
personal  selfishness.  No  less  authority  than  our  own 
Homer  Lea  in  his  work,  "The  Valor  of  Ignorance,"  very 
aptly  sa3^s  that  questions  of  right  and  honor  between 
nations  are  alwa3^s  settled  diplomatically,  only  those  in- 
volving material  interests  are  settled  by  force.  Therefore, 
why  not  place  the  conquerors  of  pain  and  suffering,  the 
emancipators  from  premature  deaths  and  invalidism  at 
least  on  a  level  with  the  conquerors  of  gold  mines,  oil  fields, 
and  trade  routes,  especially  since  the  blessings  of  the 
former  are  not  confined  to  narrow  national  interests,  but 
possess  the  broad  international  benefits  that  include  all 
peoples  of  all  countries  for  all  succeeding  ages  ? 

In  fact,  there  seems  to  be  something  fundamentally 
defective  in  human  nature,  which  neither  our  civilization 
nor  our  Christian  training  has  been  able  to  correct,  that 
permits  us  to  grow  hysterical  over  the  heroes  of  war,  and 
to  remain  indifferent  to  the  heroes  of  peace. 

Why  not  put  the  emotionalism  of  war  into  action  during 
peace  and  through  its  influence  discharge  some  of  the 
debts  of  gratitude  so  long  overdue  that  we  owe  to  those 
who  did  so  much  for  the  welfare  of  the  entire  human  race  ? 
It  would  require  but  a  relatively  small  amount,  as  "  drives" 
and  campaigns  nowadays  go,  to  secure  a  memorial  that 
would  be  commensurate  with  the  services  that  this  heroine 
jointly  with  McDowell  has  rendered  humanity  and  will 
render  it  throughout  the  succeeding  ages. 

If  there  is  no  response  from  her  sex  individually,  may 
we  not  hope  at  least  for  some  action  from  her  sex  collec- 
tively; not  because  of  the  pride  involved,  but  because  of 
the  gratitude  it  would  represent,  since  women  were  the 

312 


JANE  TODD  CRAWFORD 

first  beneficiaries  of  this  historic  experiment?  Failing  in 
this,  a  concerted  action  might  be  arranged  which  would 
include  the  women  as  the  first  beneficiaries,  the  medical 
profession  whose  art  and  science  has  been  so  enriched 
through  this  operation  as  the  second,  and  lastly  the  laity 
whose  status  through  the  diminution  of  suffering  and 
invalidism,  and  the  reduction  of  the  number  of  pre- 
mature deaths,  has  improved  beyond  all  the  bounds  of 
human  imagination. 

The  brilliant  surgery  of  the  liver  and  the  biliary  system, 
the  intricate  operations  involving  the  gastro-intestinal 
tract,  not  to  mention  the  surgery  of  the  pelvis  are  a  few 
of  the  fruits  of  the  first  ovariotomy.  If  we  consider 
only  that  very  frequent  inflammatory  disturbance 
known  as  appendicitis,  the  former  ravages  of  which 
annually  caused  the  deaths  of  thousands  of  human 
beings  who  under  present  conditions  would  now  be 
saved,  we  should  have  in  this  alone  a  sufficient 
justification  for  our  appeal.  It  is  within  the  memory  of 
all  of  us  to  recall  individual  deaths  that  were  formerly 
referred  to  as  due  to  cholera  morbus,  inflammation  of  the 
bowels,  inflammation  of  the  stomach,  and  peritonitis  that 
we  now  know  were  nothing  more  than  acute  appendicitis, 
which  is  now  properly  diagnosed  and  successfully  cured 
through  operative  measures. 

It  is  not  unreasonable  to  assume  that  this  very  disease 
prematurely  caused  the  death  of  McDowell  himself.  It 
has  been  referred  to  as  an  acute  attack  of  "inflammation 
of  the  stomach"  by  some,  and  as  "inflammatory  fever" 
by  others,  and  if  our  assumption  is  correct,  he  most  likely 
would  now  have  been  saved  through  the  benefits  of  his 
own  achievements. 

In  bringing  to  a  close  what  might  with  more  accuracy  be 

313 


JANE  TODD  CRAWFORD 

called  a  critical  study  of  these  historic  figures  rather  than 
biographies  of  McDowell  and  Mrs.  Crawford,  we  shall 
feel,  if  we  have  materially  aided  in  correcting  some  of  the 
errors  and  explaining  some  of  the  obscurities,  if  we  have 
stimulated  others  to  continue  this  study,  and  if  we  have 
succeeded  in  securing  an  adequate  recognition  of  the  ser- 
vices which  this  hero  and  heroine  have  so  generously 
rendered  the  human  race,  that  this  labor  will  not  have 
been  in  vain. 


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Van  De  Warker,  Ely:   Syracuse,  N.  Y.    Mr.  Knapp's  Painting  of  the  First 

Ovariotomy,  The  Obstetric  Gazette,  edited  by  E.  B.  Stevens,  A.M.,  M.D., 

Cincinnati,  Ohio;  vol.  i.,  1879. 
Fehr,  M.  :  Die  Ovariotomie  GeschichtHch  und  Kritich  Bearbeitet,  Heidelberg, 

1864. 
Speed,  Thomas:   The  Wilderness  Road,  A  Description  of  the  routes  of  travel 

by  which  the  pioneers  and  early  settlers  first  came  to  Kentucky,  prepared 

for  the  Filson  Club,  John  P.  Morton,  Louisville,  Ky.,  1886. 
:  The  Political  Club,  Danville,  Ky.,  1786-1790,  being  an  account  of  an 

earlyKentucky  Debating  Society,  from  the  original  papers  recently  found, 

prepared  for  the  Filson  Club,  John  P.  Morton,  Louisville,  Ky.,  1894. 
Collins,  Lewis:  History  of  Kentucky,  vol.  i.  and  ii. 

Dinsmore,  John  Walker:  The  Scotch-Irish  in  America,  The  Winona  Publish- 
ing Co.,  Chicago,  111. 
Green,  Thomas  Marshall:  Historic  Families  of  Kentucky,  Robert  Clarke  and 

Co.,  Cincinnati,  Ohio,  1889. 
FiSKE,  John:  Old  Virginia  and  her  Neighbors,  2  vols.;  Houghton,  Mifflin  and 

Co.,  Riverside  Press,  Cambridge,  Mass. 
Thompson,  W.  N.:   Grave  of  Jane  Crawford,  the  first  subject  of  Ovariotomy; 

Jour.  Am.  Med.  Ass.,  1913,  k. 

\/ :  Correction, The  Grave  of  Jane  Crawford;  Jour.  Am.  Med.  Ass.,  I9i3,lx. 

Emiliani,  Emilio  de  Faenza:   Storia  della  Estirpazione  di  una  Ovaia  esequita 

dal  Prof.  Gsetano  Emihani  redatta  dal  dottor;  Bulletino  della  Scienza 

Mediche  Bologna,  1843,  page  332. 
Peyton,  J.  Lewis:   History  of  Augusta  County,  Virginia;  Samuel  M.  Yost  & 

Son,  Staunton,  Va.,  1882. 
Waddell,  Jos.  A.:  Annals  of  Augusta  County,  Virginia,  William  Ellis  Jones. 
Shaler,  N.  S.:    a  Pioneer  Commonwealth,  Houghton  Mifflin  &  Co.,  Boston. 
Historical  Number,  Kentucky  Medical  Journal,  vol.  xv.,   No.   ii.,  Bowling 

Green,  Ky. 
LocKwooD,  Mary  S.:    Abstracts  from  the  records  of  Augusta  County,  Va., 

vols.  i.  and  ii.   The  Commonwealth  Printing  Co.,  Rosslyn,  Va. 
Corson,  Eugene  R.:  John  Bell,  Surgeon,  Johns  Hopkins  Bulletin,  vol.  xxiii.. 

No.  258,  August,  1912. 
Sir  Charles  Bell,  The  Man  and  His  Work,  Johns  Hopkins  Bulletin,  vol.  xxi.,  No. 

231,  June,  1910. 

318 


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Peter,  Robert,  M.D.  and  Peter,  Johanna:  Transylvania  University.  Its 
Origin,  Rise,  Decline  and  Fall;  Filson  Club  Publication  No.  ii;  John  P. 
Morton  &  Co.,  Louisville,  Ky. 

:   The  History  of  the  Medical  Department  of  Transylvania  University, 

Filson  Club  PubUcation,  No.  20,  John  P.  Morton  &  Co.,  Louisville,  Ky.,  1 905 . 

Williams,  Stephen  W.,  M.D.:  Williams  Medical  Biography,  L.  Meriani  &  Co., 
Printers,  Greenfield,  Mass. 

KtfSTER,  Ernst:  Geschichte  Der  Neuren  Deutschen  Chirurgie,  Ferdinand 
Enke,  Stuttgart,  1915. 

Transactions  Amer.  Gynecological  Soc,  vol.  xxxiv.,  Philadelphia,  1909,  Wm.  J. 
Dornan. 

Price,  Samuel  W.:  The  Old  Masters  of  the  Blue  Grass,  Filson  Club  Publica- 
tion No.  17;  John  P.  Morton,  Louisville,  Ky. 

Valentine,  Mrs.  Mary  T.  :  The  Biography  of  Ephraim  McDowell,  Second 
Edition  Revised,  published  by  the  author,  1894. 

:   Biography  of  Ephraim  McDowell,   Revised  Edition,  published  by 

McDowell  Publishing  Company,  New  York,  1897. 

Biography  of  Ephraim   McDowell,   First    Edition,    published   by 


McDowell  Publishing  Company,  1897  (containing  only  sketches  and  por- 
traits of  prominent  living  surgeons  of  that  period  (1897). 

Transactions  Ky.  State  Med.  Society,  13th  Session,  1868;  19th  Session,  1874; 
2ist  Session,  1876;  22nd  Session,  1877;  23rd  Session,  1878;  24th  Ses- 
sion, 1879;  25th  Session,  1880. 

ScHACHNER,  August:  Dr.  Ephraim  McDowell,  "Father  of  Ovariotomy";  His 
Life  and  His  Work,  The  Johns  Hopkins  Hospital  Bulletin,  vol.  xxiv. 

Kentucky  State  Federation  of  Women's  Clubs,  1912-1913,  Westerfield- 
Bonte  Co.,  Louisville,  Ky. 

Washburn,  Mabel  Thacher  Rosemary:  Crawford  Ancestry,  Scottish  His- 
tory of  the  Ancient  Family  of  Crawford,  The  Journal  of  American  History, 
vol.  xii.,  No.  3,  1918. 

Mitchell    J.  Knox:   Personal  Communications. 

Crawford,  Amelia  M.:  Personal  Communications. 

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Railey,  C.  a.:   Personal  Communications. 

Smith,  Thos.,  Jefferson,  Mrs.:   Personal  Communication. 

Irvine,William  M.  Mrs.      Personal  Communications. 

McCoRMACK,  J.  N.:  Personal  Communication. 

QuiSENBERRY,  J.  A.:  Personal  Communications. 

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Schachner,  August:  Louisville  Medical  Club. 

A  Reply  to  the  Bulletin  Board  of  Trustees,  University  of  Louisville, 
issued  by  the  Louisville  Medical  Club. 

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Medical  Education  and  Municipal  Hospitals;    Some  Vital  Criticisms,   New 

York  Medical  Journal,  August    21,  1915. 
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Education  In  the  U.  S.  before  and  during  the  War  of  Independence. 
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Lea,  Homer:  The  Valor  of  Ignorance,  Harper  Bros.,  New  York  and  London. 
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Yard  and  Company,  New  York,  1909. 


320 


INDEX 


Abbey  of  Cambuskenneth,  218 

American  Medical  Association,  Trans- 
actions of,  220,  231,  233,  McDowell 
Memorial  Fund,  234 

Alva,  Oklahoma,  residing  place  of 
McDowell's  granddaughter,  226 

Anaesthesia,  dependence  of  ovariotomy 
upon,  200 

Alexander,  Capt.  Archibald,  3,  2o6 

Alexander,  Elizabeth,  4 

Alexander,  Col.  J.  McD.,  45 

America,  arrangement  of  at  close  of 
French  and  Indian  Wars,  7 

American  Gynecological  Society,  81, 
252,    report  of   centenary  exercises, 

255 

Amherst,  Gen.  Sir  Jeffrey,  23 

American  Medical  Biography,  105, 
quotation  from,  66 

Amputation,  first  successful  hip  joint,  5 1 

Ancestry  of  Dr.  E.  McDowell,  1-5 

Analytical  Table  of  McDowell's  pub- 
lished cases,  122 

Analytical  Table  of  McDowell's  unpub- 
lished cases,  123 

American  Colonies,  151 

American  Medical  Recorder,  188 

Audubon,  J.  J.,  early  resident  of  Dan- 
ville, 254 

Atlee,  John  L.,  1 59,  advocate  of  ovari- 
otomy, 163;  the  Atlees,  200,  236 

Atlee,  W.  L.,  146,  table  of  ovariotomies, 
155;  dedication  of  his  work  to  Mc- 
Dowell, 157;  extracts  from  his  address, 
163-164;  220,  229,  235,  247 

Anderson,  Dr.  Turner,  240,  242 

Art  Institute  of  Chicago,  227 

Ashby,  Dr.  T.  A.,  presents  gavel  from 
McDowell  house  to  American  Gyne- 
cological Society,  255 

Asylum  for  Deaf  and  Dumb,  Gov.  Mc- 
Creary's  reception  at,  246 

Author's  address  before  Ky.  Fed. 
Women's  Clubs,  on  McDowell  house, 
261;  negotiations  with,  266-270; 
difficulties  in  attempt  to  memorialize 
McDowell  house,  259-278 

Augusta  County  Court  records  of,  19 


Augusta  College,  160 

Anderson,  Col.  A.  A.,  married  Catherine 

McDowell,    217;    the    home     where 

Mrs.  McDowell  died,   217 

Barkley,  Dr.  A.  H.,  220 

Beattie,  Doctor,  former  president  of 
Centre  College,  and  former  occu- 
pant of  McDowell  house,  268 

Birney,  James,  G.,  eariy  resident  of 
Danville,    254 

Baker,  Mrs.,  nurse  of  Jane  T.  Crawford, 
(>! 

Balcony  Falls,  2 

Bardstown,   17,  52 

Bell,  John  and  Sir  Charles,  contrasted 
with  William  and  John  Hunter,  37 

Bell,  Sir  Charles,  his  early  career  in 
London,    27 

Bell,  John,  XIV,  sketch  of,  29-39,  63, 
84,  92,  117,  151,  187,  and  Sir  Charies, 
186;  212 

Blue  Spring  branch  of  Caney  Fork, 
exact  location  of  Crawford  farm  and 
cabin,  296 

Brockenb  rough,  companion  of  Mc- 
Dowell, 21 

Breckinridge,  Dr.  Stanhope  P.,  ad- 
dress of  welcome,  70 

British  Medical  Journal,  103 

British  Empire,  represented  at  centen- 
nial celebration  banquet,  256 

Brown,  Samuel,  sketch  of,  21-22,  50, 
212,  226 

Brown,  James  Crawford,  66,  grandson 
of  Jane  Todd  Crawford,  298,  303 

Byant,  Mrs.,  one  of  McDowell's  cases, 
130 

Bowyer,  Col.  John,  3 

Blundell,  Prof.  James,  Researches, 
Physiological  and  Pathological,  91 

Bumm,  Ernst,  XIII 

Burden,  or  Borden's,  grant,  2;  character 
of  settlers  upon,  5 

Burden,  Benjamin,  Jr.,  3 

Brashear,  Walter,  first  successful  hip 
joint  amputation,  51;  sketch  of,  52; 
161,  226 


21 


321 


INDEX 


Burr,  Aaron,  23,  254 

Burial  place  of  E.  McDowell,  2 

Bellinger,   Dr.  J.,  early  ovariotomist, 

159,    160,    advocate  of  ovariotomy, 

163,  200 
Bezzi,  Prof.,  early  Italian  ovariotomist, 

169 
Bozeman,  155,  156 
Bradford,  J.  J.,  160 
Bradford,  Josh.  T.,  sketch  of,  160 
Bracken  County,  160 
Bernard,  C.  L.,  plea  for  ovariotomy,  178 
Boinet's,  work  on  ovarian  tumors,  175; 

Bozzi,  Augustus,  pioneer  London  ovari- 
otomist, 193 

British  School,  role  of  in  ovariotomy, 
179;  relationship  to  second  and  third 
period  in  evolution  of  ovariotomy, 
180 

Buhring,  of  Berlin,  favoring  ovariotomy 
in  Germany,  166 

Brown,   Baker,   English   ovariotomist, 

174;  179 
Bulletino  della  Scienza  Mediche,  Bol- 
ogna, 167 
Bodine,  Dr.  J.  M.,  personally  subscribes 

to  McDowell  Monument  Fund,  241; 

also  subscribes  on  behalf  of  University 

of  Louisville,  241 
Boyle  County  Medical  Society,  starts 

movement  to  honor  McDowell,  233, 

238 
Bryant,  Thomas,  243 
Busey,  Dr.  S.  C,  236 
Byford,    W.    H.,    Trustee    McDowell 

Memorial  Fund,  235 

Camp  Knox,  early  Post  OfBce  of  Jane 

Todd  Crawford,  296 
Cambuskenneth,  the  country  home  of 

McDowell,  218 
Caney  Fork,  61,  location  of  Crawford 

cabin,  296 
Cathrall,  Dr.  J.,  107 
Cazeaux,    defender   of   ovariotomy   in 

France,  164;  165 
Centre  College,  17,  215,  232,  258,  268, 

279 
Civiale,  Jean,  158 
Corson,  Dr.  Eugene,  R.,  28 
Coffer,  Dr.  William,  121 
Cowan,  136 
Collins,  Lewis,  quotations  from,  49,  55, 

220 


College  of  Physicians  and  Surgeons,  158, 
220 

College  of  Physicians  and  Surgeons, 
158 

Civil  War,   159 

Clay,  Dr.  Chas.,  early  English  ovari- 
otomist, 161;  179,  192,  197,  198 

Clark,  Gen.  George  Rogers,  49 

Crow's  Station,  15 

Chesney,  J.  P.,  Interesting  Incidents  in 
Private  Life  of  McDowell,  79 

Cincinnati,  158,  161,  centenary  cele- 
bration in,  256-257 

Cincinnati  Medical  Repertory,  80 

Court  records  of  Augusta  County,  19 

Criticism  of  Lawson  Tait's  views,  150- 
152 

Cloquet,  Jules  Germain,  opposes  ovari- 
otomy in  France,  165 

Congleton,  Doctor,  father-in-law  of 
John  Bell,  37 

Cruveilhier,  opposes  ovariotomy  in 
France,   165 

Cooke,  John  Esten,  54 

Chrysmar,  of  Isny,  second  ovariotomist 
irrespective  of  country,  166,  170; 
report  of  his  cases,  171-173;  sketch 
of,   173 

Cyclopedia,  American  Medical  Bio- 
graphy, H.  A.  Kelly's,  161,  220,  229 

Crawford,  Jane  Todd,  XIV,  XV,  61, 
repeats  Psalms  during  operation,  66; 
extract  from  letter,  136;  her  claims  to 
a  division  of  honors,  162;  neglected  in 
history  and  forgotten  by  humanity, 
284-285;  significance  of  her  historic 
rdle,  288-290;  Dr.  L.  A.  Sayre's  tri- 
bute to,  290;  tracing  her  movements, 
290-291;  299,  ancestry  of,  292;  296, 
family  bible  passes  to  Rev.  James 
Crawford,  292;  genealogy  of  Craw- 
ford family  by  M.  T.  R.  Washburn, 
293-295;  arrival  in  Kentucky,  296; 
sell  farm  and  cabin  to  J.  Motley,  297; 
children  of,  297;  movements  after 
leaving  Greensburg,  297-299;  makes 
home  with  daughter,  Alice  C.  Brown, 
298;  claims  to  equal  honors  with 
McDowell,  301;  age  of  and  date  of 
death,  295;  description  of  Crawford 
farm  and  cabin,  302;  uncertainty  as 
as  to  date  of  death,  303 ;  the  search 
for  and  discovery  of  her  grave,  303- 
309;  her  grave  in  Johnson  Cemetery, 
308;  inscription  on  tombstone,  308; 


322 


INDEX 


Crawford,  Jane  Todd,  the  debt  due 
her  from  her  sex,  310,  313 

Crawford,  Hon.  Thomas,  Howell, 
youngest  child  of  JaneTodd  Crawford, 
300;  tribute  from  Judge  J.  S.  Pirtle  to, 
300;  death  result  of  accident,  300; 
Mayor  of  Louisville,  300 

Crawford,  Miss  Amelia  M.,  grand- 
daughter of  Jane  Todd  Crawford, 
291;  former  patient  of  S.  D.  Gross, 
291;  assists  in  developing  the  history 
of  the  Crawfords,  291 

Crawford,  Thomas,  61,  husband  of  Jane 
Todd  Crawford,  and  member  of  In- 
diana legislature,  298;  is  accidentally 
killed,  298 

Crawford,  Rev.  James,  son  of  Jane  Todd 
Crawford,  292 

Centenary  celebration,  of  first  ovari- 
otomy, 251-256;  lost  opportunities  at, 
251;  253,  centenary  exercises  by  Mc- 
Dowell Medical  Society,  Cincinnati, 
256-257 

Cowling,  Dr.  Richard  Oswald,  243, 
presents  McDowell  door  knocker  to 
Dr.  S.  D.  Gross,  248;  presentation 
address,  248-249;  250 

Cecil,  M.  H.,  occupant  of  Cambus- 
kenneth,  218 

Chandler,  Mrs.  W.  T.,  granddaughter 
of  McDowell,  226 

Cook,  Dr.  J.  L.,  240,  favors  petition 
legislature  on  behalf  McDowell  Mon- 
ument Fund,  241 

Cooper,  Sir,  Astley,  comparison  of  his 
fees  with  those  of  McDowell's,  216 

Daviess,  Joseph,  Hamilton,  early  resi- 
dent of  Danville,  254 

DaCosta,  reference  to  hip  joint  am- 
putation,   5 1 

Daniel,  Walker,  15 

Danville,  early  history  of,  15-16;  size 
of  in  1789,  49;  importance  of,  49;  sur- 
gery during  McDowell's  life-time, 
69,  158,  253,  217,  early  importance 
of,  254;  lack  of  interest  in  McDowell 
landmarks,  257-258 

Dark  and  Bloody  Ground,  13 

Davidge,  John  Beale,  sketch  of,  21;  23 

Darwin,  Charles,  146 

Delaporte's,    views    upon   ovariotomy, 

d'Escher,  Samuel  Hartman,  thesis  of, 
176,  186 


Demarquay,  early  French  ovariotomist, 
179 

Delano,  Mrs.,  McDowell's  eighth  case, 
127;  129 

DiefFenbach,  Johann  F.,  opposes  ovari- 
otomy in  Germany,  166 

Drake,  Daniel,  54,  127,  report  upon 
Mrs.  Delano,   128;   129 

Dropsy  of  Left  Ovary,  by  Robt.  Hous- 
toun,  147 

Dudley,  Benjamin  W.,  53,  sketch  of, 
54;  duel  between  Dudley  and  Rich- 
ardson, 55;  161,  226 

Dunlap,  Dr.  Fayette,  letter  from,  74; 
75,  80,  220,  254,  speaker  at  centenary 
banquet  held  in  Cincinnati,  257 

Duncan,  Matthews,  opponent  of  ovari- 
otomy, 163 

Dutoit,  Dr.,  statistics  upon  ovariotomy 
in  Germany,  174 

Dunlap,  Dr.  A.,  early  ovariotomist, 
159;  advocate  of  ovariotomy,  163; 
200 

Dzondi,  155,  156 

Dickinson,  Dr.  Robert,  L.,  designer  of 
McDowell  Memorial  Medallion,  255 

Davis,  Dr.  Edward,  P.,  speaker  at 
centennial  banquet,  256 

David,  the  First,  218 

Davenport,  P.  W.,  painter  of  Mc- 
Dowell's portrait,  223,  226,  227 

Dudley,  Dr.  E.  C,  speaker  at  centennial 
banquet,   256 

Durham,  Judge  M.  J.,  reception  fol- 
lowing McDowell  Memorial  Exercises, 
246 

Dunmore's  War,  205 

Dunmore,  Lord,  last  of  Virginia's 
colonial  Governors,  205 

Douglas,  Eari  of,  218 

Eclectic  Repertory,  86,  106,  107,  118 
Edinburgh  Medical  and  Surgical  Jour- 
nal, xvn,  91,  loi,  187,  190,  191, 

193- 
Emillani's,  Emilio,  report  of  his  father's 

case,  167-169 
Emillani,    Dr.    Gaetano,    of    Faenza, 

claims  as  second  ovariotomist,   166- 

167 
England,  first  successful  ovariotomy  in, 

203 
Erhart,  Mr.   Frederick,   draws  ground 

plan  of  McDowell  house,  280-281 


323 


INDEX 


Fairfield,  where  McDowell  spent  his 
childhood,  204 

Father  of  American  Surger)',  104 

Father  of  Ovariotomy  and  Founder  of 
Abdominal  Surgery,  85 

Faculty  of  Medicine  of  Montpellier,  176 

Fairlawn,  56 

Fehr,  his  claims  in  behalf  of  Emiliani, 
166 

French  Academy  of  Medicine,  discus- 
sions upon  ovariotomy,  164,  166;  174 

Feoratini,  Dr.,  statement  of  early 
ovariotomies  in  Italy,  169 

Fishback,  Dr.  James,  54 

Floyd,  John,  5 

Flint,  Joshua  B.,  opponent  of  ovari- 
otomy,  163 

France,  progress  of  ovariotomy  in,  175; 
stubbomess  of  opposition  to,  177 

Frontier,  importance  of,  39-43;  advan- 
tages of,  64,  65 

Footnote,  Louisville  City  Hospital 
situation,  39 

Federal  City,  former  name  of  Washing- 
ton, D.  C,  254 

Filson  Club  Publication,  No.  17,  223 

French  University,  203 

Gastrotomy,  early  term  for  ovariotomy, 

199 
Gait,  Dr.  W.   C,    125,   Extract  from 

letter  to,  126 
Gallup,  early  ovariotomist,  159 
Galenzowski,  155,  156 
Germany,  early  ovariotomies  in,  171- 

173;  174.  257 
Geschichte,     Der    Neuren    Deutschen 

Chirurgie,  132 
Gilmore,  Miss,  130,  131 
Goodtell,  John,  52 
Great  Britian,  117,  143,  152,  203 
Granville,    Dr.    A.    B.,    see   Augustus 

Bozzi,  193,  203 
Goldsmith,  Alban,  see  Alban  G.  Smith, 

sketch  of,  158,  200 
Goldsmith,  Middleton,  sketch  of  158- 

159 

Green,  quotation  from,  2;  3 

Georgetown,  17 

Greenlee,  John,  i 

Greenlee,  Mary  McDowell,  5;  witti- 
cisms of,  6 

Greensburg,  61 

Gregory,  Dr.  James,  controversy  with 
John  Bell,  34-35 


Gross,  Samuel  D.,  22,  66,  69,  70,  102 
pen  picture  of  Physick,  105,  124,  133 
quotations  from,  25,  44,  134,  155,  156 
215,  217,  220,  describes  results  of  Am 
Med.  Ass.,  237;  suggests  world  wide 
subscriptions  to  McDowell  Fund,  241; 
officiates  at  McDowell  Memorial  Ex- 
ercises, 243,  247,  received  McDowell 
doorknocker,  248;  replies  to  Cowling's 
address,  249,  250,  282,  291,  299,  303 

Gurlt,  E.,  quotation  from,  132 

Grundy,  Felix,  17 

Geurin,  opposition  to  ovariotomy  in 
France,   165 

German  successor  of  McDowell,  200 

Goffe,  Dr.  J.  Riddle,  date  of  McDowell's 
death,  220 

Gorham,  John,  a  paper  upon  ovari- 
otomy, 196 

Greensburg,  county  seat  of  Green 
County,  location  of  Crawford  cabin, 
296 

Hawkins,  Caesar,  first  to  perform  a 
successful  ovariotomy  in  a  London 
Hospital,  197 

Harrodsburg,  first  district  court,  5 

Harrison,  Dr.  Burr,  52 

Hamilton,  Alexander,  23 

Harrison,  Benjamin,  4 

Handyside,  Dr.,  64,  second  ovarioto- 
mist in  Scotland,  190 

Henderson,  Dr.  Thomas,  31,  118 

Henry  Patrick,  4 

Hewson,  107 

Hevin,  M.,  paper  before  Royal  Academy 
Surgery,  175 

Hirsch,  Dr.  August,  quotation  from, 
132 

Hosack,  David,  sketch  of  23-24,  107 

Hodge,  Hugh  L.,  address  on  life  of  Dr. 
James,    108 

Houstoun,  Robert,  146,  "a  Dropsy  of 
the  Left  Ovary,"  147-149,  176,  198, 

247  . 
Hofmeier,  Prof.,  opinion  on  priority  of 

first  successful  vaginal  hysterectomy 

174;  speaker  at  centennial  celebration 

banquet,  256 
Hopfer,    Dr.,    reporter  of  Chrysmar's 

cases,   171-173;  sketch  of  Chrysmar, 

173 
Holmes,  Oliver  Wendell,  XVH,  letter 
upon  McDowell  Memorial  Exercises, 
244-245 


324 


INDEX 


Huguier,  opposes  ovariotomy  in  France, 
165,    180,    181 

Hufland,  quotation  from,  127 

Humphreys,  or  Humphries,  Dr.  Alex- 
ander, preceptor  of  McDowell,  18-20 

Hunters,  John  &  William,  XV,  186 

Hunter,  John,  107;  quotation  from,  141; 
186,  187,  197 

Hunter,  William,  The  History  of  an 
Emphysema,  l8i;  182-184,  185  quo- 
tation from,  140 

Hesse,  Mr.  Henry,  photographer  of  the 
McDowell  landmarks,  222,  273 

Howard,  Dr.  E.  L.,  237 

Heroes  of  war  compared  with  heroes  of 
peace,  310-313 

Houston,  Rev.  Sam,  who  officiated  at 
the  marriage  of  Thomas  Crawford  and 
Jane  Todd,  296 

Irvine,  Margaret,  I 

Ireland,  151 

Isny,  Wiirtemburg,  home  of  Chrysmar, 
first  successor  of  McDowell,  166;  200 

Invitation  to  McDowell  centennial 
celebration,  reproduction  of,  255 

Irvine,  Isaac  Shelby,  268 

Irvine,  Mrs.  Wm.  M.,  220,  223,  author's 
appeal  to,  266;  her  response  to  our 
appeal,  266-270;  pledges  $4000.00, 
267;  extracts  from  her  letters,  267-69; 
author's  negotiations  with,  266-270 

James  the  Second,  and  James  the  Fifth, 
218 

James,  17 

Jackson,  Gen.  Andrew,  40,  125 

Jackson,  John  D.,  69,  220,  231,  interests 
himself  in  behalf  of  McDowell's 
memory,  232,  233,  sketch  of,  232; 
trustee  of  McDowell  Memorial  Fund, 
23s;  238,  259 

James,  Thomas,  C,  XVIII,  sketch  of, 
106;  109,  117,  166 

Jeaffreson,  William,  XVII,  pioneer 
British  ovariotomist,  194;  195,  pro- 
test from,  196;  first  to  perform  a  suc- 
cessful ovariotomy  in  England,  197; 
203 

Johnson,  Elizabeth,  160 

Johnson,  Dr.  James,  sarcasm  of,  68; 
criticisms  of  report  of  first  ovari- 
otomies, 81-93,  108;  quotation  from, 
91;  131,  133,  138 

Johnston,  E.  Polk,  220 


Johnstone,  Dr.  A.  W.,  reception  follow- 
ing McDowell  Memorial  Exercises, 
246 

Johnson  Cemetery,  the  burial  place  of 
Jane  Todd  Crawford,  308 

Johns  Hopkins,  Bulletin,  286 

Johns  Hopkins,  Historical  Club,  au- 
thor's paper  before,  285 

Jouett,  Matthew  Harris,  painter  of 
McDowell's  portrait,  223;  225 

Kellar,  J.  M.,  XVII,  introduces  Boyle 
County  Medical  Society  resolutions 
into  Am.  Med.  Ass.,  233;  238,  241, 
Trustee  McDowell  Memorial  Fund, 

23s 
Kentucky,  early  development  of,  10-14; 
admission  into  Union,  13;  hospitality 
in,  70;  sacredness  of  life  in,  143 
Kentucky  State  Medical   Society,   ad- 
dress of  welcome  to  74;  extract  from 
transactions  of,   126,   160,  222,  234, 
237,  246,  299  _ 
Kentucky  Medical  Journal,  Historical 

Number,  130,  220,  223 
Kentucky  School  of  Medicine,  159 
Kimball,  advocate  of  ovariotomy,   163 
Koeberle,    early   French    ovariotomist, 

.179 

King,  R.  C,  pioneer  British  ovarioto- 
mist, 193;  194,  195 

Kuhn,  Dr.  Adam,  107 

Kuster,  Dr.  Ernst,  quotation  from,  132; 
133 

Kentucky  Academy,  156 

Kelly,  Dr.  Howard,  A.,  Cyclop.  Am. 
Med.  Biog.,  161;  220,  229,  speaker 
at  centennial  celebration  banquet, 
256 

Knapp,  Prof.  George  Kasson,  painter  of 
McDowell's  portrait  and  "The  First 
Ovariotomy,"  230;  231 

Ky.  State  Fed.  of  Woman's  Clubs,  is 
appealed  to,  259;  260,  meeting  at 
Mammoth  Cave,  261,  author's  ad- 
dress before,  261-265;  adopts  resolu- 
tion and  creates  McDowell  Memorial 
Committee,  266;  author  requested  to 
become  financial  secretary  of,  266;  271 

Larrey,  Dominique,  Jean,  51 

Lancet,  The  (London)  Jaeffreson's  pro- 
test in,  196 

Landi,  Prof,  of  Pisa,  reputed  first 
successful  ovariotomist  in  Italy,  169 


325 


INDEX 


L'Aumonier,  102,  155,  156 

Lee,  Robert,  opponent  of  ovariotomy, 

163 
Lewis,  Thomas,  4 

Liston,  opponent  of  ovariotomy,  163 
Letcher,  Dr.  J.  L.;  240 
Lea,  Homer,  "The  Valor  of  Ignorance," 

311 

Lexington,  Va.,  17,  204 

Lexington,  Ky.,  17 

Linnaeus,   107 

LeDran,  157 

Lincoln,  Abraham,  frontiersman,  40; 
uncertainty  of  relationship  with  Jane 
Todd  Crawford;  293 

Lister,  Sir  Joseph,  influence  upon  early 
ovariotomy,  202 

Limestone,  17 

Limestone  Creek,  17 

Lizars,  John,  XVI,  63,  64,  83,  91,  92,  93, 
loi,  103,  108,  117,  140,  171,  187,  188, 
189,  190,  failure  of  and  criticism  of, 
102,  sketch  of,  192;  his  contributions 
to  ovarian  surgery,  193;  198,  203,  213 

Logan,  Col.  Benjamin,  15 

London  Med.  Chir.  Rev.,  68,  89,  131, 
192 

London  University  Medical  Society, 
objections  to  ovariotomy,  195 

London  Hospital,  first  successful  ovari- 
otomy in,  197;  203 

Long,  Dr.  W.  H.,  remarks  on  McDowell 
monument,  240 

Long,  Dr.  Crawford  W.,  discoverer  of 
anaesthesia,   162 

Lord  Dorchester,  document  of,  16 

Louisville  City  Hospital,  footnote,  39 

Lowder,  Dr.  W.  L.,  date  of  McDowell's 
death,  220 

Majolin,  Jean  Nicolas,  157 

Martin,  of  Germany,  174 

Martin  of  Lubeck,  favoring  ovariotomy, 
166 

Marcolo,  account  of  early  ovariotomy 
in  Italy,  169 

Margaret  of  Denmark,  218 

Manton,  W.  P.,  presents  gavel  from  A. 
Dunlap  home  to  American  Gyneco- 
logical Society,  255 

Mammoth  Cave,  meeting  of  Ky.  State 
Fed.  Women's  Clubs,  at,  261 

Maysville,  17 

Massachusetts  General  Hospital,  de- 
monstration of  anaesthesia  in,  162 


Malgaigne,  opposes  ovariotomy  in 
France,  165 

McArthur,  Rev.  John,  correspondence 
relating  to  Jane  Todd  Crawford's 
grave,  306;  308 

McClung,  Miss  Mary,  4,  151 

McClung,  John,  4 

McClellan,  Dr.  Ely,  238,  259 

McKee,  Dr.  A.  R.,  reception  following 
McDowell  Memorial  Exercises,  246 

Medical  Institute,  charter  of,  158 

Meigs,  Prof.  Chas.  D.,  opponent  of 
ovariotomy,  163,  166 

Medical  Society  of  Philadelphia,  con- 
fers a  degree  upon  McDowell,  204,  23 1 

Medico-Chirurgical  Society  of  Bologna, 
167 

Metropolitan  Museum  of  Art,  227 

Meyer,  J.  M.,  238 

Memorial  Publication,  242 

McDowell,  Dr.  Ephraim,  XIV,  ancestry 
of,  I ;  birth  of,  14;  education  of,  17;  206, 
begins  the  study  of  medicine,  18;  208, 
leaves  for  Univ.  of  Edinburgh,  21,  208; 
foot  race  at  Edinburgh,  24;  vacations 
in  Scotland,  24-25 ;  study  of  his  move- 
ments by  Prof.  A.  R.  Simpson,  25-28; 
library  records  of  at  the  University, 
27;  leaves  Edinburgh  without  his 
degree,  44;  letter  from  his  father,  45; 
letter  from  A.  Reid,  47;  returns  from 
Edinburgh,  48;  character  of  his  prac- 
tice 58-60;  called  to  Jane  Todd  Craw- 
ford, 61;  supposed  disadvantages,  65; 
issues  card  in  his  defense,  66;  sarcasm 
of  Dr.  James  Johnson,  68;  his  litho- 
tomies, 69;  analysis  of  his  surgery, 
69;  where  did  he  perform  the  first 
ovariotomy.^  70;  explanation  of  criti- 
cisms upon,  77-78;  story  of  mob,  78- 
81;  reflections  upon  his  character, 
79;  advantages  of  frontier  location, 
83;  was  he  a  silent  phlegmatic  man? 
83;  significance  of  his  work,  84-85; 
his  claim  to  title.  Founder  of  Ab- 
dominal Surgery,  85;  181,  report  of 
first  three  cases,  86;  reception  ac- 
corded his  first  report,  89-93;  his  delay 
in  publishing  his  cases,  92;  comparison 
of  McDowell's  report  with  that  of 
Lizars,  loi;  second  report,  109-115, 
detailed  consideration  of  McDowell's 
operations,  116;  views  expressed  in 
letter  to  Dr.  W.  C.  Gait;  126,  total 
number   of    his    ovariotomies,    129; 


326 


INDEX 


McDowell,  Dr.  Ephraim,  McDowell's 
letter  to  Robert  J.  Thompson,  130,  de- 
fends his  claims,  133;  features  of  first 
ovariotomy,  67;  definition  of  a  sur- 
geon, 1 19;  dedication  of  W.  L.  Atlee's 
work  to,  157;  163,  166,  167,  wisdom 
of  his  method,  180;  187,  188,  debt  we 
owe  the  followers  of,  200;  German 
successor  of,  200;  202,  real  import- 
ance of  his  work,  203 ;  personal  side 
of,  204-222,  Med.  Society  of  Phila- 
delphia confers  a  degree  upon,  204, 
Fairfield,  the  place  of  his  childhood, 
204;  early  education  of,  206;  early  en- 
vironment, 207;  treatment  accorded 
his  colleagues,  209;  crafty  attempts  to 
discredit  him  210;  libellous  attempts, 
210;  never  associated  with  a  medical 
college,  210-21 1;  urged  to  publish  his 
cases,2ii-2i3;  description  of,  213-215; 
his  wealth,  215;  his  generosity,  215;  his 
fees,  215;  joins  the  church,  216; 
marries,  216;  his  children,  216-217; 
his  country  home,  217;  Cambusken- 
neth,  218;  his  illness  and  death,  219; 
conflicting  dates  of  his  death  and  birth 
220-221;  first  and  his  final  burial  spot, 
221;  disposal  of  his  first  tombstone, 
222;  removal  of  his  wife's  remains, 
222,  portraits  of,  223-231;  Boyle 
County  Medical  Society  starts  move- 
ment in  honor  of  his  memory,  233; 
description  of  memorial  monument, 
242,  Gross,  principal  speaker  of  Mc- 
Dowell Memorial  Exercises,  247; 
reproduction  of  invitation  to  centen- 
nial celebration,  255;  landmarks, 
neglect  of,  257;  efforts  to  save  the 
historic  house,  259-278;  K.  F.  W.  C, 
adopts  resolution  and  creates  Mc- 
Dowell Memorial  Committee,  266; 
failure  of  efforts  and  causes  of  278- 
279;  ground  plans  and  description  of 
McDowell  house,  280,  281;  possible 
fate  of  his  house,  282;  his  claims  on 
humanity,  312-313;  Mrs.  McDowell 
dies  at  home  of  Mrs.  A.  A.  Anderson, 
217;  donates  lot  to  Trinity  Church, 
Danville,  216 

McDowell,  Ephraim,  early  movements 
of,  I ;  what  the  span  of  his  life  covered, 
2 

McDowell,  Adaline,  daughter  of  Dr. 
Ephraim  McDowell  marries  Judge 
James  Deaderick,  217 


McDowell,  Catherine,  youngest  of  the 
surviving  children,  marries  Col.  A. 
A.  Anderson,  217 

McDowell,  Dr.  James,  66,  loi,  134,  136 

McDowell,  Capt.  John,  2 

McDowell,  Col.  Joseph,  5 

McDowell,  Dr.  Joseph  N.,  78,  "Im- 
provements Art  and  Science  Surgery 
in  Last  Fifty  Years,"  135;  comments 
upon  views,  137;  299 

McDowell  Medical  Society,  252,  Cen- 
tenary Celebration  by,  256-257 

McDowell  Memorial  Fund  in  A.  M.  A., 

234>  235 

McDowell  Publishing  Company,  228 

McDowell,  Mary,  second  daughter  of 
Dr.  Ephraim  McDowell,  marries  her 
cousin,  George  Young,  217 

McDowell,  Col.  Nick.,  81 

McDowell,  Samuel,  4;  arrival  in  Ken- 
tucky, 11;  226,  letter  to  Dr.  Ephraim 
McDowell,  45;  extract  from  letter, 
230 

McDowell,  Dr.  Marshall,  correspon- 
dence with,  223-225;  226,  227,  229 

McDowell  Park,  final  burial  spot  of  Mc- 
Dowell, 221;  222 

McDowell,  Susan,  eldest  daughter  of 
Ephraim  McDowell,  217;  marries  Col. 
David  C.  Irvine,  217 

McDowell,  William  Wallace,  son  of 
Dr.  Ephraim  McDowell,  217;  marries 
Miss  Mary  Hall,  217;  removes  to 
Missouri,  217,  226 

McDowell,  William  A.,  92,  106,  108, 
124,  129 

McKinny,  Charles,  pupil  of  McDowell, 

McMurtry,  Dr.  L.  S.,  71,  moves  ap- 
pointment of  executive  committee, 
240;  244,  chairman  McDowell  Mon- 
ument Fund  Commitee,  240;  report 
on  McDowell  Monument  Fund,  241; 
speaker  at  Centennial  Celebration 
Banquet,  256;  his  conflicting  dates  on 
McDowell's  birth  and  death,  220 

Menefee,  Richard  Jouett,  prepares  list 
of  Jouett's  paintings,  226 

McCormack,  Dr.  J.  N.,  correspondence 
concerning  McDowell  historical  mat- 
ter, 286-287 

Mitchell,  Mr.  J.  Knox,  grandnephew 
of  Jane  Todd  Crawford,  291; 
renders  valuable  aid  in  unravell- 
ing the  Crawford  history,  291-310; 


327 


INDEX 


Mitchell,  Mr.  J,  Knox,  early  history 
of  the  Mitchells,  295-296;  extracts 
from  letters  of,  298;  makes  possible 
the  discovery  of  Jane  Todd  Craw- 
ford's grave,  304;  correspondence  re- 
lating thereto,  305-309 

Mitchell,  J.  A.,  examines  records  of  the 
Crawford  farm  and  cabin,  296 

Mitchell,  Thomas,  marries  Rachel, 
sister  of  Thomas  Crawford,  296 

Michener,  Dr.  Ezra,  quotation  from, 
118 

Mutter,  Prof.,  opposes  ovariotomy,  163 

Military  Academy  at  West  Point,  254 

Morand,  157 

Mob  that  threatened  McDowell,  79 

Moreau,  opposes  ovariotomy,  165 

Morris,  J.,  Trustee  McDowell  Memorial 
Fund,  235 

Morning  Sun,  Iowa,  home  of  James  C. 
Brown,  298 

Munro,  Alexander,  Secundus,  32 

Mussey,  R.  D.,  early  defender  of 
ovariotomy,  200 

Motley's  Glen,  61,  subsequent  name  of 
Crawford  farm,  297 

Motley,  John,  who  purchased  the  Craw- 
ford farm  and  cabin,  296 

Muter,  George,  5 

Nelaton,  Auguste,  133,  174,  179 
Negresses  as  McDowell's  ovarian  cases, 

131 
North  American  Medical  and  Surgical 

Journal,  91 
National     Encyclopedia    of    American 

Biography,  extract  from  upon  Todd 

family,   292 
New  York  Legislature,  changes  Alban 

G.  Smith's  name  to  Alban  Goldsmith, 

158 

Obstetric  Gazette,  243,  editorial  com- 
ment upon  McDowell  Memorial 
Exercises,  246 

"Observations  on  Diseased  Ovaria" 
by  E.  McDowell,  109 

"Observations  on  Extirpation  of  the 
Ovaria  with  Cases"  by  John  Lizars, 
93-101 

Octerlony,  Dr.  J.  A.,  240 

O'Hara,  Keane,  early  resident  of  Dan- 
ville, 254 

O'Hara,  Theodore,  author  "The  Bi- 
vouac of  the  dead",  254 


328 


Olshausen,  favors  ovariotomy  in  Ger- 
many, 174 

Otto,  107 

O.  Mrs.,  McDowell's  sixth  case,  124-125 

Overton,  Dr.  James,  125 

Overton  fee,  Gross  compares  it  with  fee 
paid  Sir  Astly  Cooper,  216 

Ovariotomy,  special  features  of  first,  67; 
where  performed,  71-77;  report  of 
first  three  cases  of,  86;  reception 
accorded  report  of  first  cases,  89-93; 
McDowell's  second  report  upon,  109, 
explanatory  remarks  upon  McDow- 
ell's cases,  120;  analytical  table  of 
McDowell's  published  and  unpublish- 
ed cases,  122,  123;  total  number  of 
McDowell's  cases,  129;  defense  of 
McDowell's  claims,  133;  historical 
development  of,  141,  142;  permanency 
of  basic  features  of  first,  145;  priority 
of,  146;  a  product  of  the  nineteenth 
century,  158;  early  operations  in 
Unites  States,  159;  homage  due  early 
operators  and  patients,  162;  200, 
early  opinions  of  ovariotomy  in 
Philadelphia,  _  163-164;  attitude  of 
Obstetric  Society  of  London  towards, 
166;  early  progress  in  Germany,  166; 
discussions  upon  in  French  Academy 
of  Medicine,  164;  166;  Emiliani's 
supposed  case  of,  167-169;  early  ovari- 
otomies in  Italy,  169;  Chrysmar's 
cases  of,  171-173;  early  German 
statistics,  174;  development  of  in 
France,  175,  176;  Delaporte's  views 
upon,  175;  Chambon's  views,  175; 
Theden's  operation  for,  175;  stub- 
bomess  of  French  opposition  to,  177; 
first  ovariotomy  in  France,  177; 
rejection  by  metropolitan  surgeons, 
178;  relationship  of  English  School  to 
second  and  third  period  of,  180; 
attitude  of  eminent  American,  French, 
German  &  British  surgeons  towards 
ovariotomy,  191;  the  three  milestones 
in  the  British  relationship  to  the  first 
period  of  ovariotomy  192;  Lizars 
cases  of,  193;  early  nomenclature  of, 
197;  first  successful  ovariotomy  in 
England,  197;  in  London  197;  in  a 
London  Hospital,  197;  first,  second 
and  third  period  of  ovariotomy, 
197;  Sir  J.  Y.  Simpson,  suggests 
the  term  ovariotomy,  198;  complete 
and     incomplete     operations,      199; 


INDEX 


Ovariotomy,  gastrotomy  early  term  for 
ovariotomy,  199;  dependence  upon 
anaesthesia,  2CX);  names  of  pioneers 
who  struggled  for  its  adoption,  200; 
second  period  of  201 ;  202,  debatable 
details  of,  201;  slowness  of  adoption 
of,  202,  Lister's  influence  upon,  202; 
centenary  exercises  of,  251-256 

Panama  Pacific  Exposition,  McDowell 

house  souveniers  at,  273 
Parvin,  Dr.  Theophilus,  243 
Parrish,  107 

Pean,  early  French  ovariotomist,  179 
Peruzzi,    Dr.    Dominico,    reputed   first 

ovariotomist  in  Italy,  169 
Peaslee,  Dr.  E,  R.,  quotation  from,  141; 

159;  165,  extract  from,  169;  criticizes 

the  term  ovariotomy,  198;  220,  221, 

223,  227 
Perkins,    136 
Peyton,  J.  L.,  2 
Philadelphia  County  Medical  Society, 

163 
Plater,  E.,  opinion  of,  157 
Philosophical  Society,  the  Transactions 

of,   147 
Physick,   Edmund    and  Abigail   Syng, 

104 
Physick,  Phillip  Syng,  63,  92;  sketch  of, 

103-106;  117,  151,  166,  188,  212 
Plasters,    Miss,    McDowell's    seventh 

case,  125 
PIrtle,  Judge  James  S.,  tribute  to  Hon. 

T.  H.  Crawford,  300 
Princeton  University,  3 
Priestly,  Dr.  James,  17 
Practitioner,  The,  quotation  from,  37, 

220 
Proud,  Robert,  107 
Private  life  of  McDowell,  incidents  in, 

79 
Price,  Gen.  Samuel  W.,  author  of  "The 

Old   Masters  of    the   Blue  Grass," 

225 
Polk,  James  K.,  59 
Political  Club,  15 
Portraits  of  McDowell,  223-23 1 
Power,  centralization  of  in  present  age, 

144 
Power  and  Darwin,  defenders  of  The- 

den's  operation,  175 
Pozzi,    Prof.    S.,    extiact    from,     179, 

speaker    at    Centennial    Celebration 

Banquet,  256 


Quirges  (Doubs),  where  first  ovariotomy 
was  performed  in  France,  177 

Quisenberry,  John  A.,  co-operates  in 
attempt  to  save  McDowell  house, 
260;  277 

Ravenel,  W.  deC,  letter  from,  73 
Red  House  or  Maryland  tavern,  2 
Reid,  A.,  letter  to  Dr.  E.  McDowell,  47 
Revolutionary  War,  205 
Resolutions    introduced    into    medical 
organizations  in  honor  of  McDowell, 

234 

Richardson,  Dr.  T.  G.,  243 

Richardson,  Dr.  William  H.,  54 

RIdgeley,  Frederick,  22;  sketch  of,  50 

Ridenbaugh,  Mary  Young,  (see  Mrs. 
Mary  T.  Valentine)  26,  28,  79,  quo- 
tation from,  131;  193,  220,  221,  217, 
223,  227;  comments  upon  Dr.  J.  N. 
McDowell,  137-138 

Reyburn,  Dr.  Robert,  moves  to  table 
Toner's  resolution,  237 

Rogers,  Dr.  Lewis,  XVII 

Rogers,  Dr.  Coleman,  242 

Rowan,  John,  17 

Rogers,  Dr.  D.  L.,  early  ovariotomist, 
159,  160 

Rochester,  Mrs.  Lettie,  later  occupant 
of  McDowell  house,  268 

Roosevelt,  Theodore,  last  of  frontiers- 
men, 40 

Ryegate,  home  of  Mrs.  Sly,  159 

Rudnicki,  Anna,  156 

Sayre,  Dr.  Lewis  A.,  encourages  Jack- 
son's efforts,  232,  President  A.  M. 
A.,  makes  remarks  at  McDowell 
Memorial  Exercises,  243;  tribute  to 
Jane  Todd  Crawford,  290 

Settlers,  characteristics  of  early  Ken- 
tucky, 8-9,  14 

Saint  Mary,  Louisiana,  52 

Shaler,  N.  S.,  6;  8 

Speed,  Thomas,  quotation  from,  57 

Speed,  companion  of  McDowell,  21 

Simpson,  Prof.  A.  R.,  study  of  Mc- 
Dowell's movements  while  in  Edin- 
burgh, 25;  quotation  from,  103 

Shelby,  Gov.  Isaac,  4,  226 

Shelby,  Isaac,  216 

Shelby,  Sarah  Hart,  McDowell's  fiancee, 
216 

Shelby,  Miss  Mary  C,  date  of  Mc- 
Dowell's death,   220 


329 


INDEX 


Schorkoff,  Justus,  Theodore,  views  of, 
142 

Schlenker,  Ehrenfried,  views  of,  142 

Shackleford,  17 

Shepherdsville,  52 

Scotland,  21,  203 

Shakespeare,  Win.,  146,  253 

Schroeder,  of  Germany,  favors  ovari- 
otomy, 174 

Simpson,  Sir  James  Y.,  suggests  the 
term  ovariotomy,  198 

Simon,  Gustave,  statistics  of  early 
German  ovariotomy,  174 

Spanish  Intrigue,  49 

Sims,  Dr.  J.  Marion,  reads  report  of 
McDowell     Memorial     Fund,     234; 

Smithsonian  Institution,  letter  from, 
73;  227 

Society  of  Friends,  106 

Smith,  Alban  G.,  see  Alban  Goldsmith, 
158 

Smith,  Dr.  Nathan,  first  American 
successor  of  McDowell,  158,  159,  188, 
historical  significance  of  his  report, 
188-189,  200 

Smith,  Mrs.  Thomas  Jefferson,  corres- 
pondence with  concerning  McDowell 
house,  277 

Smith,  J.  Grieg,  133,  150  "Was  Robert 
Houstoun  the  First  Ovariotomist ?" 

'53-155  ^ 

Southern    Surgical    and    Gynecological 

Association,  Transactions  of,  220 
Spencer,    Sir  Herbert,  quotation   from, 

85 

Spencer,  Dr.  Herbert  R.,  represents 
British  Empire  at  Centennial  Cele- 
bration Banquet,  256;  extract  from 
address,  256 

Schultz,  Christopher,  156 

St.  Joseph's  College,  52 

Staunton  Academy,  18 

St.  George's  Hospital,  107 

Summary  of  McDowell's  ovarian  sur- 
gery, 129 

Surgery,  Gynecology  and  Obstetrics, 
221 

Swartsel,  Dr.  Samuel  Cary,  speaker  at 
centenary  celebration  held  in  Cincin- 
nati, 256 

Tait,  Lawson,  XVII,  138,  146,  Tait's 
views  of  Houstoun's  operation,  150; 
198 


Thompson,  J.  W.,  XVII,  Presidential 
address,  McDowell  monument,  238- 
240,  259 

Tevis,  Mr.  Isaac  Shelby,  occupant  of 
Traveler's  Rest,  222 

Timber  Ridge  Church,  2 

Thompson,  Robert  J.,  letter  from  Dr. 
E.  McDowell,  130 

Theden,  Johann,  C.  A.,  remarks  upon,i76 

Traveler's  Rest,  first  burial  place  of 
McDowell,  221,  where  McDowell's 
marriage  occurred,  216 

Trinity  Church,  lot  donated  by  Mc- 
Dowell, 216,  McDowell  a  member  of, 
221 

Tozetti,  Giovanni  Targioni,  views  of, 
142 

Toner,  Joseph  M.,  22;  decides  question 
upon  Mrs.  McDowell's  remains, 
222;  236,  moves  to  appropriate  ^1000 
for  McDowell  Memorial  fund,  243 

Thornton,  Dr.  J.  Knowsley,  243 

Thomas,  Dr.  T.  Gaillard,  243 

Troup,  23 

Transylvania  Seminary,  17,  18,  56 

Transylvania  University,  sketch  of  56; 
17,  52,  56,  160 

Tomlinson,  Dr.,  124 

Trowbridge,  Dr.,  early  ovariotomist, 
159,  200 

The  Journal  of  American  History, 
abstract  from  on  Crawford  family, 
293-295 

Todd,  Samuel,  Sheriff  of  Botetourt 
County,  Va.,  292;  father  of  Jane  Todd, 
292;  his  family,  292;  origin  of  Todd 
family,  292;  relationship  between 
various  Todd  families,  293;  un- 
certainty of  relationship  with  Abra- 
ham Lincoln,  293 

Turner,  Prof.  Fred  J.,  quotation  from, 
40-42 

Union,  arrangement  of  states  of,  6 

University  of  Basle,  157 

University  of  Edinburgh,  18,  25,  32 
204,  229 

University  of  Louisville,  footnote,  39, 
beginning  of,  158;  subscribes  to  Mc- 
Dowell Monument  Fund,  241 

University  of  Maryland,  confers  honor- 
ary degree  upon  McDowell,  23;  204, 
231 

University  of  Paris,  254 

University  of  Pennsylvania,  104,  107 


330 


INDEX 


Vaginal  Hysterectomy,  first  successful 
case  by  Dr.  Sauter,  174 

Valentine,  Mrs.  Mary  T.,  same  as  Mary 
Y.  Ridenbaugh,  various  editions  of 
biography  of  Ephraim  McDowell, 
227-229 

Vaullegeard,  Dr.,  second  ovariotomist 
in  France,  178;  extract  from,  178 

Velpeau,  Alfred,  L.  M.,  opposes  ovari- 
otomy in  France,  165 

Virginia,  early  characteristics  of,  8-10; 
160,  205 

Virginians,  205 

Von  Klein,  Dr.,  remarks  upon  Dr. 
Chrysmar,  173 

Waddell,  Mr.  Joseph  A.,  2,  290 

Walne,  D.  H.,  first  to  perform  a  suc- 
cessful ovariotomy  in  London,  197; 
203 

War,  the  emotionalism  of,  310-313; 
comparing  the  heroes  of  war  with 
heroes  of  peace,  310-313 

Washington,  George,  4 

Warren,  demonstrating  ether  anaesthe- 
sia, 162 

Washburn,  M.  T.  R.,  abstract  from 
paper  on  Crawford  family,  293-295 

"Was  Robert  HoustounThe  First  Ovari- 
otomist?" by    J.   Grieg  Smith,    153- 

Waterman,  Dr.  L.  D.,  236 


Wells,  Sir  Spencer,  XVII,  quotation 
from,  138,  analysis  of  same,  139,  140 
quotation  from,  142;  144,  146,  com- 
ment upon  Houstoun's  operation,  149; 
extract  from,  169;  181,  185,  error  of 
his  views,  197;  198,  223,  243,  letter 
upon  McDowell  Memorial  Exercises, 
244 

Webster,  Charles  L.  Co.,  Publisher,  228 

Weisiger,  Mr.  John,  Gil,  owner  of  Mc- 
Dowell house,  271;  negotiations  and 
correspondence  with,  271-276 

Weizegar,  Dr.,   124 

West,  W.  J.,  early  British  ovariotomist, 

.^95 

Willius,  Nicolaus,  142 

Wilderness  Road,  12,  15 

Williams  Medical  Biography,  108 

Williamsburg,  Convention  of,  4 

Worley,  17 

Wood,  or  Woods,  Magdalena,  I 

Womanhood,  the  debt  they  owe  to 
Ephraim  McDowell  and  Jane  Todd 
Crawford,   310-313 

Woodward,  Dr.  J.  J.,  237 

World  War,  3 10 

Woycikowski,  Dr.,  first  French  ovari- 
otomist, 177 

Yandell,  L.  P.,  Sr.,  XVII,  23,  160,  204, 

Yale  University,  158 


331 


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